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Cancers
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Surgery in Metastatic Cancer
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Surgery in Metastatic Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Metastasis".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 8870

Special Issue Editor

Prof. Dr. Ulrich Ronellenfitsch

E-Mail Website
Guest Editor
Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Halle (Saale), Germany
Interests: upper gastrointestinal cancer; multimodal treatment; gastrectomy; esophagectomy; sarcoma; quality of care; meta-analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Until recently, a metastatic stage of cancer was equivalent to a situation in which only palliative measures by the way of systemic therapy, radiation, or best supportive care could be applied. Surgery was carried out exclusively for symptom control or in cases of complications such as hemorrhage, bowel obstruction or organ perforation.

In recent decades, however, surgery in metastatic cancer stages by metastasectomy and/or removal of the primary tumor in the metastatic stage has been shown as a treatment that prolongs survival in various cases and might even have the aim of curing the disease in selected situations. This development is due to technical improvements and risk mitigation in surgical techniques, but also to more effective systemic treatments. The careful selection of patients for a surgical approach and the individually tailored timing of a possible operation are crucial to obtain favorable results and to avoid exposing patients to unnecessary risks of complications. While for some disease entities such as colorectal cancer with resectable liver metastases, surgery is now considered standard, for others it is still under evaluation in clinical trials.

In this Special Issue of Cancers, up-to-date original research, short communications and comprehensive review articles on all modalities playing a role in the surgical treatment of metastatic cancer will be published. Moreover, the results of preclinical studies with implications on treatment do also qualify for publication.

I look forward to your numerous submissions.

Prof. Dr. Ulrich Ronellenfitsch
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • metastatic cancer
  • surgery
  • metastasectomy
  • indication
  • timing

Published Papers (5 papers)

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Research

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13 pages, 559 KiB  
Article
New Prognostic Score (Essen Score) to Predict Postoperative Morbidity after Resection of Lung Metastases
by Konstantinos Grapatsas, Fabian Dörr, Hruy Menghesha, Martin Schuler, Viktor Grünwald, Sebastian Bauer, Hartmut H. -J. Schmidt, Stephan Lang, Rainer Kimmig, Stefan Kasper, Natalie Baldes and Servet Bölükbas
Cancers 2023, 15(17), 4355; https://doi.org/10.3390/cancers15174355 - 01 Sep 2023
Cited by 1 | Viewed by 881
Abstract
Background: Pulmonary metastasectomy (PM) is a widely accepted surgical procedure. This study aims to investigate postoperative morbidity and mortality after PM and develop a score to predict high-risk patients. Methods: We retrospectively investigated all patients undergoing a PM in our institution from November [...] Read more.
Background: Pulmonary metastasectomy (PM) is a widely accepted surgical procedure. This study aims to investigate postoperative morbidity and mortality after PM and develop a score to predict high-risk patients. Methods: We retrospectively investigated all patients undergoing a PM in our institution from November 2012 to January 2023. Complications were defined as the diagnosis of any new disease after the PM up to 30 days after the operation. Results: 1284 patients were identified. At least one complication occurred in 145 patients (11.29%). Only one patient died during the hospital stay. Preoperative cardiovascular comorbidities (OR: 2.99, 95% CI: 1.412–3.744, p = 0.01), major lung resections (OR: 2.727, 95% CI: 1.678–4.431, p < 0.01), repeated pulmonary metastasectomy (OR: 1.759, 95% CI: 1.040–2.976, p = 0.03) and open thoracotomy (OR: 0.621, 95% CI: 0.415–0.930, p = 0.02) were identified as independent factors for postoperative complications. Based on the above independent factors for postoperative morbidity, the Essen score was developed (overall correct classification: 94.6%, ROC-Analysis: 0.828, 95% CI: 0.795–0.903). Conclusion: PM is a safe surgical procedure with acceptable morbidity and low mortality. The aim of the Essen score is to identify patients that are associated with risk for postoperative complications after PM. Full article
(This article belongs to the Special Issue Surgery in Metastatic Cancer)
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17 pages, 1766 KiB  
Article
Discordant and Converting Receptor Expressions in Brain Metastases from Breast Cancer: MRI-Based Non-Invasive Receptor Status Tracking
by Alexander Heitkamp, Frederic Madesta, Sophia Amberg, Schohla Wahaj, Tanja Schröder, Matthias Bechstein, Lukas Meyer, Gabriel Broocks, Uta Hanning, Tobias Gauer, René Werner, Jens Fiehler, Susanne Gellißen and Helge C. Kniep
Cancers 2023, 15(11), 2880; https://doi.org/10.3390/cancers15112880 - 23 May 2023
Cited by 1 | Viewed by 1748
Abstract
Discordance and conversion of receptor expressions in metastatic lesions and primary tumors is often observed in patients with brain metastases from breast cancer. Therefore, personalized therapy requires continuous monitoring of receptor expressions and dynamic adaptation of applied targeted treatment options. Radiological in vivo [...] Read more.
Discordance and conversion of receptor expressions in metastatic lesions and primary tumors is often observed in patients with brain metastases from breast cancer. Therefore, personalized therapy requires continuous monitoring of receptor expressions and dynamic adaptation of applied targeted treatment options. Radiological in vivo techniques may allow receptor status tracking at high frequencies at low risk and cost. The present study aims to investigate the potential of receptor status prediction through machine-learning-based analysis of radiomic MR image features. The analysis is based on 412 brain metastases samples from 106 patients acquired between 09/2007 and 09/2021. Inclusion criteria were as follows: diagnosed cerebral metastases from breast cancer; histopathology reports on progesterone (PR), estrogen (ER), and human epidermal growth factor 2 (HER2) receptor status; and availability of MR imaging data. In total, 3367 quantitative features of T1 contrast-enhanced, T1 non-enhanced, and FLAIR images and corresponding patient age were evaluated utilizing random forest algorithms. Feature importance was assessed using Gini impurity measures. Predictive performance was tested using 10 permuted 5-fold cross-validation sets employing the 30 most important features of each training set. Receiver operating characteristic areas under the curves of the validation sets were 0.82 (95% confidence interval [0.78; 0.85]) for ER+, 0.73 [0.69; 0.77] for PR+, and 0.74 [0.70; 0.78] for HER2+. Observations indicate that MR image features employed in a machine learning classifier could provide high discriminatory accuracy in predicting the receptor status of brain metastases from breast cancer. Full article
(This article belongs to the Special Issue Surgery in Metastatic Cancer)
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Review

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17 pages, 351 KiB  
Review
The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma
by Hana Studentova, Martina Spisarova, Andrea Kopova, Anezka Zemankova, Bohuslav Melichar and Vladimir Student, Jr.
Cancers 2023, 15(15), 3855; https://doi.org/10.3390/cancers15153855 - 29 Jul 2023
Cited by 1 | Viewed by 1190
Abstract
The role of cytoreductive nephrectomy in metastatic renal cell carcinoma (RCC) has been studied intensively over the past few decades. Interestingly, the opinion with regard to the importance of this procedure has switched from a recommendation as a standard of care to an [...] Read more.
The role of cytoreductive nephrectomy in metastatic renal cell carcinoma (RCC) has been studied intensively over the past few decades. Interestingly, the opinion with regard to the importance of this procedure has switched from a recommendation as a standard of care to an almost complete refutation. However, no definitive agreement on cytoreductive nephrectomy, including the pros and cons of the procedure, has been reached, and the topic remains highly controversial. With the advent of immune checkpoint inhibitors, we have experienced a paradigm shift, with immunotherapy playing a crucial role in the treatment algorithm. Nevertheless, obtaining results from prospective clinical trials on the role of cytoreductive nephrectomy requires time, and once some data have been gathered, the standards of systemic therapy may be different, and we stand again at the beginning. This review summarizes current knowledge on the topic in the light of newly evolving treatment strategies. The crucial point is to recognize who could be an appropriate candidate for immediate cytoreductive surgery that may facilitate the effect of systemic therapy through tumor debulking, or who might benefit from deferred cytoreduction in the setting of an objective response of the tumor. The role of prognostic factors in management decisions as well as the technical details associated with performing the procedure from a urological perspective are discussed. Ongoing clinical trials that may bring new evidence for transforming therapeutic paradigms are listed. Full article
(This article belongs to the Special Issue Surgery in Metastatic Cancer)
13 pages, 1269 KiB  
Review
Surgical Approach in Metastatic Renal Cell Carcinoma: A Literature Review
by Milena Matuszczak, Adam Kiljańczyk and Maciej Salagierski
Cancers 2023, 15(6), 1804; https://doi.org/10.3390/cancers15061804 - 16 Mar 2023
Cited by 3 | Viewed by 2944
Abstract
The treatment of metastatic renal cell carcinoma has undergone considerable advances in the last two decades. Cytoreductive nephrectomy and metastasectomy retains a role in patients with a limited metastatic burden. The choice of optimal treatment regimen remains a matter of debate. The article [...] Read more.
The treatment of metastatic renal cell carcinoma has undergone considerable advances in the last two decades. Cytoreductive nephrectomy and metastasectomy retains a role in patients with a limited metastatic burden. The choice of optimal treatment regimen remains a matter of debate. The article summarises the current role of surgery in metastatic kidney cancer. Full article
(This article belongs to the Special Issue Surgery in Metastatic Cancer)
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25 pages, 393 KiB  
Review
Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice
by Valentina Fanotto, Francesca Salani, Caterina Vivaldi, Mario Scartozzi, Dario Ribero, Marco Puzzoni, Francesco Montagnani, Francesco Leone, Enrico Vasile, Maria Bencivenga, Giovanni De Manzoni, Debora Basile, Lorenzo Fornaro, Gianluca Masi and Giuseppe Aprile
Cancers 2023, 15(3), 900; https://doi.org/10.3390/cancers15030900 - 31 Jan 2023
Cited by 5 | Viewed by 1679
Abstract
The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in [...] Read more.
The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in life-threatening complications. While retrospective series have suggested that surgery on the primary tumor may confer a survival advantage even in asymptomatic patients, randomized trials seem not to definitively support this hypothesis. We discuss the evidence for and against primary tumor resection for patients with metastatic gastrointestinal (colorectal, gastric and pancreatic) cancers treated with systemic therapies and put in context the pros and cons of the onco-surgical approach in the time of precision oncology. We also evaluate current ongoing trials on this topic, anticipating how these will influence both research and everyday practice. Full article
(This article belongs to the Special Issue Surgery in Metastatic Cancer)
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