Report from the European Society of Thoracic Surgeons database 2019: current surgical practice and perioperative outcomes of pulmonary metastasectomy

OBJECTIVES: We report an overview of surgical practices and outcomes in patients undergoing pulmonary metastasectomy based on data from the European Society of Thoracic Surgeons database. METHODS: We retrieved data on resections performed for pulmonary metastases between July 2007 and July 2019. We evaluated baseline characteristics, surgical management and postoperative outcomes. Open and video-assisted thoracic surgery (VATS) procedures were compared in terms of surgical management, morbidity and mortality. RESULTS: We selected 8868 patients [male/female 5031/3837; median age: 64years (interquartile range 55-71)] who underwent pulmonary metastasectomy. Surgical approach consisted of open thoracotomy in 63.5% of cases (n=5627) and VATS in 36.5% (n=3241), with a conversion rate of 2.1% (n=69). Surgical resection was managed by wedge or local excision in 61% (n=5425) of cases and anatomical resection in 39% (n=3443); lobectomy: 26% (n=2307); segmentectomy: 11% (n=949); bilobectomy: 1% (n=95); pneumonectomy: 1% (n=92)). Lymph node assessment was realized in 58% (n=5097) [sampling: 21% (n=1832); complete dissection: 37% (n=3265)]. Overall morbidity and mortality rates were 15% (n=1308) and 0.8% (n=69), respectively. Median duration of stay was 6days (interquartile range 4-8). The rate of VATS procedures increased from 15% in 2007 to 58% in 2018. When comparing VATS and Open surgery, there were significantly (P<0.001) fewer anatomical resections by VATS (24% vs 49%), lymph node assessments (36% vs 70%), less morbidity (9% vs 18%) and shorter durations of stay (median: 4 vs 7 days). CONCLUSIONS: We report a good overview of current surgical practices in terms of resection extent and postoperative outcomes with a gradual acceptance of VATS.