University of Oulu

Karjula T, Niskakangas A, Mustonen O, Puro I, Väyrynen JP, Helminen O, Yannopoulos F. Results of intention-to-treat pulmonary metastasectomies in northern Finland revealing significant number of new lung primary carcinomas: time to move on from wedge resections? J Thorac Dis 2023;15(6):3319-3329. doi: 10.21037/jtd-22-1647

Results of intention-to-treat pulmonary metastasectomies in northern Finland revealing significant number of new lung primary carcinomas : time to move on from wedge resections?

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Author: Karjula, Topias1,2; Niskakangas, Anne1,2; Mustonen, Olli1,2;
Organizations: 1Surgery Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
2Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu, Finland
3Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: AME Publishing Company, 2023
Publish Date: 2023-09-25


Background: A considerable proportion of intended pulmonary metastasectomies is known to turn out as new incidental primary lung cancers in final pathology. We aimed to analyse the trends and results of pulmonary metastasectomies using the intention-to-treat approach with an emphasis on final histopathological findings.

Methods: All intention-to-treat pulmonary metastasectomies performed in Oulu University Hospital between 2000 and 2020 were included in the study. Long term survival was analysed with the Kaplan-Meier method and log-rank tests. A binary logistic regression analysis was performed to calculate odds ratios for incidental primary lung cancer in final histology.

Results: A total of 154 intended pulmonary metastasectomies were performed to 127 individual patients. There was an increasing trend in pulmonary metastasectomies during the study period. Despite the increasing trend in comorbidities of the operated patients, the length of hospital stays decreased, and the postoperative complication rates remained stable. In final pathology reports, 9.7% were new primary lung cancers and 13.0% were benign nodules. A long disease-free interval (≥24 months) and smoking history were associated with incidental primary lung cancer in final histology. The short-term 30- and 90-day mortalities after pulmonary metastasectomy were 0.7%. The 5-year survival after pulmonary metastasectomy from all histologies was 52.8%, and from colorectal cancer metastasectomies (n=34) it was 73.5%.

Conclusions: The significant amount of new primary lung cancer lesions in pulmonary metastasectomy specimens highlight the diagnostic importance of pulmonary metastasectomy. A segmentectomy could be considered as a primary procedure in pulmonary metastasectomy in patients with a long disease-free interval and a heavy smoking history.

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Series: Journal of thoracic disease
ISSN: 2072-1439
ISSN-E: 2077-6624
ISSN-L: 2072-1439
Volume: 15
Issue: 6
Pages: 3319 - 3329
DOI: 10.21037/jtd-22-1647
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: This study was supported by State Research Funding (VTR), Instrumentarium Science Foundation and Mary and Georg C. Ehrnrooth Foundation. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. The corresponding author had full access to all the data in the study and had the final responsibility for the decision to submit for publication.
Copyright information: © Journal of Thoracic Disease. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: