{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:21:52Z","timestamp":1780590112277,"version":"3.54.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T00:00:00Z","timestamp":1563494400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Pulmonary metastasectomy for malignant melanoma requires an individualized therapeutic decision. Due to recently developed novel treatment options, the prognosis of patients with melanoma has improved significantly. Validated prognostic factors that identify patients who are most likely to benefit from metastasectomy are urgently needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We retrospectively reviewed all consecutive patients with melanoma undergoing complete pulmonary metastasectomy between January 2010 and December 2016. The impact of age, sex, extrapulmonary metastases, preoperative systemic therapy, number of metastases, laterality and largest diameter of metastasis on survival after metastasectomy was analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 29 male and 32 female patients were included in the study. The median follow-up time was 25.6\u2009months. The mean number of resected metastases was 1.7\u2009\u00b1\u20091.1 (range 1\u20135). Ten patients had repetitive pulmonary metastasectomies. The median survival time was 31.3\u2009months with a 2-year survival rate of 54%. Bilateral metastases or multiple nodules were not associated with a significantly decreased overall survival rate after metastasectomy. Shorter overall survival times were observed in male patients [hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.42\u20135.92; P\u2009=\u20090.0035] and in patients with nodules larger than 2\u2009cm (HR 3.18, 95% CI 1.45\u20136.98; P\u2009=\u20090.004). In multivariable analysis, both gender and tumour size remained significant independent prognostic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Excellent overall survival rates after pulmonary metastasectomy for melanoma metastases were observed in patients with a metastatic diameter less than 2\u2009cm and in female patients. In view of improved long-term outcome due to novel treatment options, the selection of patients for pulmonary metastasectomy based on prognostic factors will become increasingly important.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezz211","type":"journal-article","created":{"date-parts":[[2019,6,28]],"date-time":"2019-06-28T19:09:29Z","timestamp":1561748969000},"page":"1104-1109","source":"Crossref","is-referenced-by-count":11,"title":["Prognostic factors for pulmonary metastasectomy in malignant melanoma: size matters"],"prefix":"10.1093","volume":"56","author":[{"given":"Jan","family":"Viehof","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Livingstone","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Loscha","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Stockhammer","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"},{"name":"Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Bankfalvi","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Hospital, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Pl\u00f6nes","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Mardanzai","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Sucker","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Schadendorf","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University Hospital, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balazs","family":"Heged\u00fcs","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7787-991X","authenticated-orcid":false,"given":"Clemens","family":"Aigner","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Medicine Essen\u2014Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,18]]},"reference":[{"key":"2019111903501463500_ezz211-B1","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1111\/jdv.15322","article-title":"Time trends in incidence and mortality of cutaneous melanoma in Germany","volume":"33","author":"Garbe","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2019111903501463500_ezz211-B2","doi-asserted-by":"crossref","first-page":"472","DOI":"10.3322\/caac.21409","article-title":"Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual","volume":"67","author":"Gershenwald","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"2019111903501463500_ezz211-B3","first-page":"193","article-title":"Prognostic factors in 1,521 melanoma patients with distant metastases","volume":"181","author":"Barth","year":"1995","journal-title":"J Am Coll Surg"},{"key":"2019111903501463500_ezz211-B4","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/annonc\/mdz011","article-title":"Five-year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001","volume":"30","author":"Hamid","year":"2019","journal-title":"Ann Oncol"},{"key":"2019111903501463500_ezz211-B5","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.ejso.2016.11.001","article-title":"Metastasectomy in cutaneous melanoma","volume":"43","author":"Lasithiotakis","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"2019111903501463500_ezz211-B6","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0022-5223(19)34957-8","article-title":"Analysis of 945 cases of pulmonary metastatic melanoma","volume":"103","author":"Harpole","year":"1992","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019111903501463500_ezz211-B7","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1054\/bjoc.2000.1335","article-title":"Lung metastases from melanoma: when is surgical treatment warranted?","volume":"83","author":"Leo","year":"2000","journal-title":"Br J Cancer"},{"key":"2019111903501463500_ezz211-B8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S0022-5223(05)80017-0","article-title":"Resection and adjuvant immunotherapy for melanoma metastatic to the lung and thorax","volume":"110","author":"Tafra","year":"1995","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019111903501463500_ezz211-B9","doi-asserted-by":"crossref","first-page":"S187","DOI":"10.1097\/JTO.0b013e3181dcf96d","article-title":"Pulmonary metastasectomy for melanoma","volume":"5","author":"Oliaro","year":"2010","journal-title":"J Thorac Oncol"},{"key":"2019111903501463500_ezz211-B10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1615\/CritRevOncog.2016014729","article-title":"Metastasectomy for stage IV melanoma in the era of effective systemic agents","volume":"21","author":"Ollila","year":"2016","journal-title":"Crit Rev Oncog"},{"key":"2019111903501463500_ezz211-B11","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1093\/ejcts\/ezv168","article-title":"Statistical and data reporting guidelines for the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery","volume":"48","author":"Hickey","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2019111903501463500_ezz211-B12","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1016\/j.athoracsur.2009.08.033","article-title":"Surgical management of pulmonary metastases","volume":"88","author":"Erhunmwunsee","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"2019111903501463500_ezz211-B13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/ejcts\/ezx063","article-title":"Growth patterns of pulmonary metastases: should we adjust resection techniques to primary histology and size?","volume":"52","author":"Welter","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2019111903501463500_ezz211-B14","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/jso.25326","article-title":"Indications for the surgical resection of stage IV disease","volume":"119","author":"Bello","year":"2019","journal-title":"J Surg Oncol"},{"key":"2019111903501463500_ezz211-B15","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/cncr.29134","article-title":"The rise in metastasectomy across cancer types over the past decade","volume":"121","author":"Bartlett","year":"2015","journal-title":"Cancer"},{"key":"2019111903501463500_ezz211-B16","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/BF02523659","article-title":"Does endogenous immune response determine the outcome of surgical therapy for metastatic melanoma?","volume":"7","author":"Hsueh","year":"2000","journal-title":"Ann Surg Oncol"},{"key":"2019111903501463500_ezz211-B17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejca.2018.08.008","article-title":"The impact of effective systemic therapies on surgery for stage IV melanoma","volume":"103","author":"Smith","year":"2018","journal-title":"Eur J Cancer"},{"key":"2019111903501463500_ezz211-B18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2217\/mmt-2016-0018","article-title":"Surgical resection of metastatic melanoma in the era of immunotherapy and targeted therapy","volume":"4","author":"Tyrell","year":"2017","journal-title":"Melanoma Manag"},{"key":"2019111903501463500_ezz211-B19","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1002\/jso.23938","article-title":"Post-operative survival following metastasectomy for patients receiving BRAF inhibitor therapy is associated with duration of pre-operative treatment and elective indication","volume":"111","author":"He","year":"2015","journal-title":"J Surg Oncol"},{"key":"2019111903501463500_ezz211-B20","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jtcvs.2006.08.065","article-title":"Improved survival with pulmonary metastasectomy: an analysis of 1720 patients with pulmonary metastatic melanoma","volume":"133","author":"Petersen","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019111903501463500_ezz211-B21","doi-asserted-by":"crossref","first-page":"2847","DOI":"10.1245\/s10434-007-9448-y","article-title":"Stage-IV melanoma and pulmonary metastases: factors predictive of survival","volume":"14","author":"Neuman","year":"2007","journal-title":"Ann Surg Oncol"},{"key":"2019111903501463500_ezz211-B22","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1055\/s-0030-1250669","article-title":"Survival after pulmonary metastasectomy in patients with malignant melanoma","volume":"59","author":"Schuhan","year":"2011","journal-title":"Thorac Cardiovasc Surg"},{"key":"2019111903501463500_ezz211-B23","doi-asserted-by":"crossref","DOI":"10.1111\/jdv.15667","article-title":"Prolonged overall survival following metastasectomy in stage IV melanoma","author":"Elias","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2019111903501463500_ezz211-B24","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/j.athoracsur.2018.06.078","article-title":"Clinical outcomes after pulmonary metastasectomy for melanoma: a population-based study","volume":"106","author":"Hanna","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2019111903501463500_ezz211-B25","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/CMR.0b013e3283632cbe","article-title":"Pulmonary metastasectomy for malignant melanoma: prognostic factors for long-term survival","volume":"23","author":"Younes","year":"2013","journal-title":"Melanoma Res"},{"key":"2019111903501463500_ezz211-B26","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1245\/s10434-011-2197-y","article-title":"Surgical management of melanoma lung metastasis: an analysis of survival outcomes in 292 consecutive patients","volume":"19","author":"Chua","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"2019111903501463500_ezz211-B27","doi-asserted-by":"crossref","first-page":"3991","DOI":"10.1245\/s10434-017-6072-3","article-title":"Long-term survival after complete surgical resection and adjuvant immunotherapy for distant melanoma metastases","volume":"24","author":"Faries","year":"2017","journal-title":"Ann Surg Oncol"},{"key":"2019111903501463500_ezz211-B28","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1038\/jid.2010.354","article-title":"Gender differences in melanoma survival: female patients have a decreased risk of metastasis","volume":"131","author":"Joosse","year":"2011","journal-title":"J Invest Dermatol"},{"key":"2019111903501463500_ezz211-B29","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1038\/s41591-018-0197-1","article-title":"Neoadjuvant immune checkpoint blockade in high-risk resectable melanoma","volume":"24","author":"Amaria","year":"2018","journal-title":"Nat Med"},{"key":"2019111903501463500_ezz211-B30","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1056\/NEJMoa1709030","article-title":"Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma","volume":"377","author":"Weber","year":"2017","journal-title":"N Engl J Med"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/56\/6\/1104\/30960705\/ezz211.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/56\/6\/1104\/30960705\/ezz211.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T10:23:18Z","timestamp":1663842198000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/56\/6\/1104\/5535678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,18]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,7,18]]},"published-print":{"date-parts":[[2019,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezz211","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,12]]},"published":{"date-parts":[[2019,7,18]]}}}