VATS anatomical resection (lobectomy or segmentectomy) for pulmonary metastasis

Stéphane Renaud, Michel Gonzalez, Pierre-Emmanuel Falcoz


Metastasectomy is steadily gaining place in the arsenal of treatments of patients suffering from lung metastasis of colorectal carcinoma (CRC). Meanwhile thoracotomy has been the gold standard approach during years for lung metastasectomy of CRC, the use of video-assisted thoracic surgery (VATS) in this field is currently thriving. Indeed, in addition of known advantages of minimally-invasive surgery, VATS has shown equivalent oncologic outcomes in comparison to open techniques. Otherwise, several questions in the management of these particular patients remained unsolved. In particular, only few studies have explored the role of anatomical resections (i.e., segmentectomy/lobectomy/pneumonectomy) compared to wedge resections. Despite their low level of evidence, these studies highlight interesting preliminary results, in particular a survival advantage of anatomical resections over non-anatomical. Most recent works have even suggested a potential role of molecular markers to select candidates who would benefit from an anatomical resection.