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Table 1 Major series reporting surgical management of pulmonary metastases from gynaecological malignancies

From: Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review

First Author Year of Publication Number of Cases Primary Tumour Pattern of Metastasis Surgery Survival/Recurrence Outcomes Prognostic Factors
Adachi [29] 2015 23 Epithelial gynecologic cancers Major series reporting suCervical – 60.9 %
Endometrial – 17.4 %
Ovarian – 21.7 %
1 nodule – 69.6 %
2–3 nodules – 30.4 %
VATS – 56.5 %
Conventional thoracotomy – 43.5 %
5 year OS:
Cervical – 61 %
Endometrial – 100 %
Ovarian – 100 %
Recurrence – 43.4 %
Univariate analysis – positive prognostic factors for survival:
Endometrioid vs mucinous adenoca
DFI >2 years
Gonzalez Casaurran [19] 2011 27 Uterine and cervical cancer 1 metastasis – 66.7 %
2 metastases – 18.5 %
≥2 metastases – 14.8 %
Surgical approach:
- thoracotomy – 81.5 %
- sequential bilateral – 7.4 %
- unilateral VATS – 3.7 %
- sequential bilateral VATS – 3.7 %
- VATS + thoracotomy – 3.7 %
Lung resection:
- Wedge resection – 81.5 %
- Lobectomy – 11.1 %
- Other – 7.4 %
Second surgery for metastases - 18.5 %
Median survival from diagnosis of metastases – 94 months
5-year OS after diagnosis of metastases – 84.1 %
Overall relapse rate 44 %
Positive prognostic factors
Primary site – endometrial vs cervical (P = 0.023)
DFI >24 months (p = 0.054)
Burt [22] 2011 82 Sarcoma
Included male and female patients
Leiomyosarcoma – 31 cases (38 %) - 24 pts (77 %) of these were female
In female pts, uterus most common primary site
Solitary metastases – 16 pts (52 %)
Bilateral disease – 19 %
- Wedge resection – 71 %
- Lobectomy – 23 %
- Segmentectomy – 6 %
- VATS – 58 %
5 year survival:
- Leiomyosarcoma – 52 %
- other sarcoma – 32 %
2nd pulmonary metastasectomy – 58.5 %
Second pulmonary recurrence - 30.5 %
Multivariate analysis – DFI >12 months from time of primary tumour resection
Lim [90] 2010 21 Primary and recurrent cervical cancer Not reported 23 resections in 21 patients
- thorocatomies – 43.5 %
- VATS – 52.2 %
- VATS following thoracotomies – 4.3 %
Procedures – 49
- wedge resections – 51.1 %
- lobectomies – 18.4 %
- mediastinal LN dissections – 24.5 %
- segmentectomy – 2.0 %
- diaphragmatic resection −2.0 %
- pleurectomy – 2.0 %
Note – only 14 patients had recurrent cervical cancer, and 1 patient had primary lung cancer and mediastinal LN metastasis from cervical cancer
Median f/up 16 months (range 2–67)
- 2 pts died of disease
- 3 pts alive with disease
- 16 pts alive without disease
Not reported
Clavero [23] 2006 70 Uterine corpus – 52.9 %
Endometrium – 32.9 %
Cervix – 10.0 %
Ovaries – 2.9 %
Vagina – 1.3 %
Histopathology:
Leiomyosarcoma – 41.4 %
Adenocarcinoma – 32.9 %
Other sarcoma – 15.7 %
SCC −7.1 %
Other – 2.9 %
Median number of lung metastases – 2 (range 1–19) Wedge excision – 63 %
Lobectomy – 20 %
Bilobectomy – 3 %
Pneumonectomy – 2.5 %
Combination – 12.5 %
5-year OS 46.8 % (95 % CI 34.2-63.0 %)
10 year OS – 34.3 % (95 % CI 19.7-52.5 %)
Factors that adversely affected survival:
DFI between 1st gynecologic procedure and pulmonary resection <24 months (p = 0.004)
Primary site in cervix (p < 0.001)
Yamomoto [28] 2004 29 (out of 7748 = 0.37 %) Cervical cancer (Stage Ib or II treated with curative intent surgery or radiotherapy) Solitary metastasis – 58.6 %
Multiple metastases – 43.4 %
Wedge resection – 27.6 %
Segmentectomy – 6.9 %
Lobectomy – 65.5 %
Hilar or mediastinal lymph node dissection – 55.2 %
5 year DFS after pulmonary metastasectomy – 32.9 % For DFS:
- ≤2 metastases
- SCC
Anraku [21] 2004 133 Uterine malignancies (cervix and endometrium) Histopathology:
SCC – 43.6 %
Cervical adenocarcinoma – 9.8 %
Endometrial adenocarcinoma – 17.3 %
Choriocarcinoma – 12.0 %
Leiomyosarcoma – 4.7 %
Solitary metastasis −58 %
2–3 mets – 23 %
≥4 mets – 17
%
Wedge resection – 50 %
Lobectomy – 45 %
Bilobectomy – 2.5 %
Pneumonectomy – 2.5 %
Overall survival after surgical resection:
5-year – 54.6 %
10-year – 44.9 %
5-year survival by histpathological type:
SCC – 46.8 %
Cervical adenoca – 40.3 %
Endometrial adenoca – 75.7 %
Choriocarcinoma – 86.5 %
Leiomyosarcoma – 37.9 %
Univariate analysis – negative prognostic factors:
Primary tumour in cervix
DFI <12 months
Resection ≥ 4 mets
Large tumour size (≥3 cm)
Multivariate analysis:
DFI < 12 months
Anderson [20] 2001 82 eligible pts
25 underwent pulmonary resection
Eligible patients:
Uterine – 73.2 %
Cervical – 26.8 %
Patients undergoing resection:
Uterine – 76.0 %
Cervical – 24.0 %
Solitary – 28 %
Multiple – 72 %
Uterine:
- Wedge – 63.1 %
- Lobectomy – 10.5 %
- Lobectomy/wedge – 15.8 %
- Bilobectomy – 5.3 %
- Segmentectomy – 5.3 %
Cervix:
- Wedge – 66.7 %
- Lobectomy – 33.3 %
Uterine cancer
- median survival 26 months
- Leiomyosarcoma −25 months
- Adenocarcinoma – 46 months
Cervix cancer
- median survival 36 months
Uterine cancer – favourable prognostic factors:
Leiomyosarcoma vs adenocarcinoma (p = 0.02)
Levenback [27] 1992 45 Uterine sarcomas:
- Leiomyosarcoma – 84 %
- Endometrial stromal sarcoma – 9 %
- Mesodermal mixed tumours – 7 %
Unilateral lesions – 71 %
1 lesion – 51 %
Nodules >2 cm – 70 %
Staged thoracotomies – 100 %
Median sternotomy and bilateral resections – 4.4 %
Incomplete resection – 36 %
From time of pulmonary resection:
- 5 year survival – 43 %
- 10 year survival – 35 %
Median follow-up – 89 months
Disease recurrence – 42 %
Significant predictors:
- unilateral vs bilateral disease
Not significant:
- metastasis size
- number of metastases
- disease free interval
- patient age
  1. VATS video-assisted thoracoscopic surgery, OS overall survival, DFI disease free interval