Anatomical Versus Non-Anatomical Pulmonary Metastasectomy: European Multicentre Analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objectives: Pulmonary metastasectomy is not a standardised procedure, with no consensus regarding the optimal extent of lung resection. This international multicentre study aimed at comparing short and long-term outcomes of anatomical versus non-anatomical pulmonary metastasectomy. Methods: Retrospective database including 1647 patients aged ≥18 years, who underwent curative intent pulmonary metastasectomy between January 2010 and December 2018 at 15 European centres. Patients who underwent pneumonectomy, previous metastasectomies, and/or suffered from extrapulmonary recurrence at the time of lung surgery were excluded. Primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and 30-day morbidity. Differences between the two groups were analysed using 3:1 matching. Results: In the matched cohort, 324 patients underwent anatomical resection, and 830 patients underwent non-anatomical resection. Five-year overall survival was 62.0%. Averaged over the entire follow-up, there was no significant difference in overall survival between the two groups (HR = 1.122, 95% CI = 0.909–1.385, p = 0.283). In the early period following pulmonary metastasectomy, anatomical resections were associated with worse overall survival (HR = 1.549, 95% CI = 1.135–2.114, p = 0.006). The difference in any-site recurrence-free survival between the two groups was not significant (HR = 0.832, 95% CI = 0.690–1.002, p = 0.053). Locoregional recurrence-free survival was significantly longer after anatomical resection (HR = 0.651, 95% CI = 0.520–0.817, p < 0.001). Thirty-day morbidity was significantly higher after anatomical resection (22.2% versus 13.7% for non-anatomical resections, p = 0.001). Conclusions: In a highly selected cohort, non-anatomical resection showed comparable survival and lower morbidity compared to anatomical resections, supporting the surgical strategy of favouring limited resections whenever technically and oncologically feasible. Anatomical resections remain a valid option in selected cases with acceptable outcomes.
Source: Cancers
Authors: Elena Prisciandaro, Luca Bertolaccini, Steffen Fieuws, Andrea Cara, Lorenzo Spaggiari, Lin Huang, René Petersen, Marco Lucchi, Maria Mastromarino, Annalisa Barbarossa, Paul De Leyn, Matteo Roffinella, Enrico Ruffini, Abid Donlagic, Michel Gonzalez, Marta Fuentes-Gago, Clara Forcada-Barreda, Maria Congedo, Stefano Margaritora, Yaniss Belaroussi, Matthieu Thumerel, Jérémy Tricard, Pierre Felix, Nina Lebeda, Isabelle Opitz, Angela De Palma, Giuseppe Marulli, Cesare Braggio, Pascal Thomas, Frankie Mbadinga, Jean-Marc Baste, Bihter Sayan, Bedrettin Yildizeli, Jeroen Dekervel, Dirk E. Van Raemdonck, Walter Weder, Laurens Ceulemans
Institutions: Universitair Ziekenhuis Brussel, University of Bologna, University of Milan, European Institute of Oncology, KU Leuven, Copenhagen University Hospital, Rigshospitalet, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Universitair Ziekenhuis Leuven, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Turin, Centre Hospitalier Universitaire Vaudois, Universidad de Salamanca, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Centre Hospitalier Universitaire de Bordeaux, Centre Hospitalier Universitaire de Limoges, University Hospital Zurich, University of Bari Aldo Moro, Hôpital Nord, Centre Hospitalier Universitaire de Rouen, Marmara University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7140147746