Background: Metastatic pancreatic and periampullary adenocarcinoma is associated with a poor prognosis, with a life expectancy of less than one year at diagnosis, a 5-year survival rate of only 1-2%, and a median survival of 3 to 6 months. In the Philippines, pancreatic cancer is the 14th most common cancer and the 8th leading cause of cancer-related death, with over 153,000 cases and 92,600 deaths reported in 2020. Current literature suggests that in carefully selected patients, synchronous resection of primary pancreatic and periampullary adenocarcinoma with liver metastases can yield favorable surgical outcomes with low morbidity and mortality. However, survival outcome data for such cases within the Philippine population remain limited. Objective: To evaluate survival rates in patients with pancreatic and periampullary adenocarcinoma with oligometastasis who underwent pancreatic resection and metastasectomy at the Philippine General Hospital from 2011 to 2021. Methods: A retrospective cohort study was conducted using data collected from the Department of Surgery’s electronic medical records, cross-referenced with the Philippine Statistics Authority’s death registry. Inclusion criteria included patients aged 19 and above with histologically confirmed pancreatic and periampullary adenocarcinoma with three or fewer metastases. Descriptive statistics were calculated, and Kaplan-Meier survival analysis was used to determine overall survival rates. Results: Of the patients reviewed, 75% were female, with a median age of diagnosis of 60 years. Tumor locations included the pancreatic head (50% of cases), ampullary region (37.5%), and pancreatic body/tail (12.5%). The 1-year survival rate was 62.5%, the 2-year survival rate was 25%, and the median overall survival was 17.3 months, with a range from 7 to 28.8 months. Conclusion The findings suggest that synchronous resection of primary tumors and metastases may offer survival benefits for selected patients with metastatic pancreatic and periampullary cancers. However, further prospective clinical trials are necessary to confirm the potential survival advantage of this approach in a broader population.
metastasectomy

RATIONALE: The liver is the most common site of metastasis from colorectal cancer. Curative intent liver metastasectomy has shown improvement in overall survival. This manuscript will present the long-term oncologic outcomes of hepatic metastasectomy for colorectal cancer with resectable liver metastasis. METHODS: Data of patients with resectable liver metastases from colorectal cancer who underwent hepatic resection at the Philippine General Hospital over a 10-year period was reviewed. The primary outcome investigated was overall survival. RESULTS: Thirty patients were included in the study. The median overall survival was 20 months, with a 2-year and 5-year overall survival rate of 40% and 6.67% respectively. Eleven (36.67%) patients had disease recurrence, with a median disease-free survival of 16 months. A significant difference in survival was seen between patients with synchronous and metachronous liver metastasis (20.38 and 36.78 months respectively, p=0.0393) and in patients given adjuvant chemotherapy at any time in relation to the occurrence of the liver metastases versus patients who did not receive any adjuvant treatment (34.08 and 18.59 months respectively, p=0.0349). Trends towards improved overall survival were seen in patients 50 years old or less (36.86 versus 21.78 months, p=0.0837) and in patients with a clinical risk score of 2 or less (29.65 versus 19.62 months, p=0.1823), which may show significance in a higher powered study CONCLUSION Improved overall survival was observed among patients with colorectal liver metastases undergoing hepatic metastasectomy compared to no liver resection.
Metastasectomy ; Philippines

The lung is a common site for metastasis of malignant tumors from other organs. The metastatic cascade is a complex process that involves a series of events. Tumors can spread to the lung through hematogenous or lymphangitic routes. In the absence of extrathoracic metastasis, complete resection is associated with increased survival, regardless of histology. With appropriate patient selection, life expectancy is often improved with pulmonary metastasectomy. Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) are 2 approaches that have been increasingly reported for pulmonary tumors. Although these new therapies have yet to match the long-term success rates of surgical therapy, the techniques demonstrate good results in treating high-risk surgical candidates with metastatic lesions to the lungs that would otherwise be considered with resection. This review will focus on the role of local therapy in oligometastasis that arise in the lung.
Life Expectancy ; Lung ; Metastasectomy ; Neoplasm Metastasis ; Patient Selection

PURPOSE: We performed a comparative analysis of the clinicopathologic features and oncologic outcomes of colorectal cancer patients with metachronous versus synchronous metastasis, according to the prognostic factors. METHODS: Ninety-three patients who underwent curative resection for distant metastatic colorectal cancer were included in the study between December 2001 and December 2011. We assessed recurrence-free survival and overall survival in patients with distant metastasis who underwent curative surgery. RESULTS: The most common site of distant metastasis was lung alone (n = 19, 51.4%) in patients with metachronous metastasis, while liver alone was most common in those with synchronous metastasis (n = 40, 71.4%). Overall survival rate was significantly different between patients with synchronous metastasis and metachronous metastasis (34.0% vs. 53.7%; P = 0.013). Incomplete resection of the metastatic lesion was significantly related to poor overall survival in both, patients with synchronous metastasis, and metachronous metastasis. CONCLUSION: Our study indicates that patients developing distant metastasis after initial treatment show a different metastatic pattern and better oncologic outcomes, as compared to those presenting with distant metastasis. Resection with tumor free margins significantly improves survival in patients with metachronous as well as synchronous metastasis.
Colorectal Neoplasms* ; Humans ; Liver ; Lung ; Metastasectomy* ; Neoplasm Metastasis* ; Survival Rate

This is a report of successful management for pulmonary metastasis following chemotherapy in patient with testicular germ cell tumor. Postchemotherapy PET-CT was not uptake FDG in metastatic lesion. Pulmonary metastasectomy was performed, which is important to manage a residual postchemotherapy lung mass in testicular germ cell tumor for histological correlation with primary testicular lesion to select the patients who require subsequent chemotherapy. Our patient was well 6 months after operation, not carried out chemotherapy because of no viable tumor.
Germ Cells ; Humans ; Lung ; Metastasectomy ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal ; Testicular Neoplasms ; Testis

Benign metastasizing leiomyoma (BML) is a rare entity, characterized by the occurrence of multiple smooth muscle nodules in the lung with histologically benign leiomyoma. Both the uterine and pulmonary tumors have been found to express estrogen and progesterone receptors, which suggest that the pulmonary lesions represented metastases from leiomyoma. We experienced a 41-year-old female patient with BML and report here with the literature review.
Adult ; Estrogens ; Female ; Humans ; Leiomyoma* ; Lung Neoplasms ; Lung* ; Metastasectomy ; Muscle, Smooth ; Neoplasm Metastasis ; Receptors, Progesterone

BACKGROUND: Surgical resection is a standard treatment for pulmonary metastases in patients with osteosarcoma, but the role of performing repeated resections is not clear. This study was designed to clarify the feasibility of performing a repeated pulmonary metastasectomy and the prognostic factors for pulmonary metastases in patients with osteosarcoma. MATERIAL AND METHOD: Between January 1990 and July 2005, 62 patients with osteosarcoma were diagnosed with pulmonary metastases and 36 patients underwent pulmonary resection. We reviewed the patients retrospectively. RESULT: The total number of pulmonary metastasectomies was 62 in 36 patients. Among 36 patients, 18 had a second metastasectomy, 7 had a third metastasectomy, and one patient had a fourth metastasectomy. There was no distinctive difference between the first and second metastatectomy in terms of median survival time, and the 3-year and 5-year survival rate (first resection: 20.5 months, 32.6% and 29.4%; second resection: 11.3 months, 34.9% and 34.%). However, the median survival time (7.1 months) was shorter in patients with a third metastatectomy than in patients with one metastatectomy (p=0.01). In long-term survivors, the number of female patients, patients with a disease free time longer than 12 months, patients with a single metastasis and patients with anatomic resection was larger when compared to non-long term survivors, but showed no statistical significance. CONCLUSION: Repeated pulmonary metastasectomy is expected to prolong survival time in patients with osteosarcoma, and is expected to increase long-term survival in selected cases. Further studies with a large number of patients are necessary.
Female ; Humans ; Lung Neoplasms ; Metastasectomy* ; Neoplasm Metastasis ; Osteosarcoma* ; Retrospective Studies ; Survival Rate ; Survivors

PURPOSE: To assess the relative frequency of benign and metastatic nodules in patients in whom nodules were resected due to suspected metastasis, and to compare the CT features of these nodules with pathologic findings in resected specimens. MATERIALS AND METHODS: Ninety-four pulmonary nodules resected by pulmonary metastasectomy in 31 patients with extrathoracic malignancies were included in our study. We retrospectively analyzed the CT features of each nodule with regard to size, shape, margin characteristics, the presence or absence of cavity, location and distance from the pleura. RESULTS: Among 94 resected nodules, 67 (71 %) were metastatic, and 27 (29 %), were benign. Among the pathologically benign nodules, involvement was as follows : fibrosis (n=14), intrapulmonary lymph node (n=7), necrosis (n=3), organizing pneumonia (n=2) and xanthogranulomatous inflammation (n=1). The mean diameter of metastatic nodules was 10.9 (range, 1-30) mm, and that of benign nodules 6.0 (range, 1-30) mm. Statistically significant differences in nodule size were found between the two groups (p<0.05), though CT revealed no significant differences in terms of shape, margin, the presence or absence of cavity, location and distance from the pleura. CONCLUSIONS: Twenty-nine percent of surgically resected nodules in patients with extrathoracic malignancies were benign. Although the possibility of metastatic nodule increases with larger nodule size, the correct diagnosis of pulmonary nodules requires histopathologic confirmation or monitoring of serial changes in nodule size.
Diagnosis ; Fibrosis ; Humans ; Inflammation ; Lymph Nodes ; Metastasectomy ; Necrosis ; Neoplasm Metastasis ; Pleura ; Pneumonia ; Retrospective Studies

PURPOSE: To assess the relative frequency of benign and metastatic nodules in patients in whom nodules were resected due to suspected metastasis, and to compare the CT features of these nodules with pathologic findings in resected specimens. MATERIALS AND METHODS: Ninety-four pulmonary nodules resected by pulmonary metastasectomy in 31 patients with extrathoracic malignancies were included in our study. We retrospectively analyzed the CT features of each nodule with regard to size, shape, margin characteristics, the presence or absence of cavity, location and distance from the pleura. RESULTS: Among 94 resected nodules, 67 (71 %) were metastatic, and 27 (29 %), were benign. Among the pathologically benign nodules, involvement was as follows : fibrosis (n=14), intrapulmonary lymph node (n=7), necrosis (n=3), organizing pneumonia (n=2) and xanthogranulomatous inflammation (n=1). The mean diameter of metastatic nodules was 10.9 (range, 1-30) mm, and that of benign nodules 6.0 (range, 1-30) mm. Statistically significant differences in nodule size were found between the two groups (p<0.05), though CT revealed no significant differences in terms of shape, margin, the presence or absence of cavity, location and distance from the pleura. CONCLUSIONS: Twenty-nine percent of surgically resected nodules in patients with extrathoracic malignancies were benign. Although the possibility of metastatic nodule increases with larger nodule size, the correct diagnosis of pulmonary nodules requires histopathologic confirmation or monitoring of serial changes in nodule size.
Diagnosis ; Fibrosis ; Humans ; Inflammation ; Lymph Nodes ; Metastasectomy ; Necrosis ; Neoplasm Metastasis ; Pleura ; Pneumonia ; Retrospective Studies

BACKGROUND: Surgical resection is accepted widely as the standard therapy for complete resectable pulmonary metastases. The number of cases of pulmonary metastasectomy and its survival rate is increasing due to the development of the therapeutic modalities. We attempted to analyze the survival rate and prognosis factors of pulmonary metastasectomy during the last 10 years. MATERIAL AND METHOD: We retrospectively analyzed the data of 89 patients who underwent 96 procedures of pulmonary metastasectomy between January 1996 and December 2005. The factors that may influence the long term prognosis such as completeness of resection, the type of primary cancer, the disease-free interval, the number and size of metastasis and the laterality were investigated. RESULT: There was no operative mortality. The mean disease free interval (DFI) was 29.6+/-27.9 months and there were 3 cases of synchronous metastasis (3.4%). The overall 3, 5 and 10 year survival rate was 52.5%, 32.1% and 20.7%, respectively. The median survival time was 38 months. The 5-year survival rate according to the IRLM appraisal was 63.5%, 33.3%, 22.1% and 0% for stage I, II, III and IV, respectively. Univariate analysis showed a better prognosis for patients with a disease free interval of 36 months or more, unilateral metastasis and 4 or less metastases. CONCLUSION: The survival rate for completely resectable pulmonary metastasectomy was favorable. The disease free interval, laterality and the number of metastasis were the prognosis factors.
Humans ; Metastasectomy* ; Mortality ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Survival Analysis ; Survival Rate