{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T09:18:29Z","timestamp":1787995109331,"version":"build-2784847793"},"reference-count":31,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004103","name":"Landsp\u00edtali H\u00e1sk\u00f3lasj\u00fakrah\u00fas","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004103","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Surg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and aims:<\/jats:title>\n                    <jats:p>Pulmonary metastases are generally associated with poor prognosis, and only a selected subset of patients undergo surgery. However, population-level data on outcomes remain limited. This study aimed to evaluate temporal trends and outcomes of pulmonary metastasectomy (PM) in a nationwide cohort over more than two decades.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective cohort study included all patients who underwent PMs in Iceland between 2001 and 2021. The study period was divided into three 7-year intervals for comparison. Survival was evaluated from the first PM using the Kaplan\u2013Meier analysis, and prognostic factors were assessed using multivariable Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 179 PMs were performed, with procedure volume increasing significantly during the final study period. The median age at the first PM was 62\u2009years, and 54% of patients were male. The most common indication was metastatic colorectal carcinoma (39.3%), followed by renal cell carcinoma (16.4%) and sarcoma (10%). Median follow-up was 52\u2009months. Early major postoperative complications occurred in 2.2% of cases, with a 30-day mortality rate of 1.1%. Five-year overall survival was 49.7%, and 55.5%, 60.9%, and 35.7% for colorectal carcinoma, renal cell carcinoma, and sarcoma tumor subtypes, respectively. Five-year overall survival increased significantly from 31% to 55% across the first and last 7-year periods. In addition to sarcoma histology and an operation in the first period, negative prognostic factors included advanced age, a greater number of metastases, and a prior extrathoracic metastasectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The use of PM increased over time and was accompanied by improved long-term survival, likely reflecting advances in systemic therapy, imaging, and patient selection. The procedure had a low rate of major complications, and 5-year survival rates were comparable to those reported in international data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14574969261468491","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:10:16Z","timestamp":1785899416000},"page":"354-363","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary metastasectomy in Iceland: Long-term nationwide trends and outcomes"],"prefix":"10.1177","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0664-087X","authenticated-orcid":false,"given":"Carlos Magnus","family":"Rabelo","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland"},{"name":"Faculty of Medicine, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6840-7462","authenticated-orcid":false,"given":"Luis Gisli","family":"Rabelo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland"},{"name":"Faculty of Medicine, University of Iceland, Reykjavik, Iceland"},{"name":"Department of Medical Oncology, Landspitali University Hospital, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigurdis","family":"Haraldsdottir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Iceland, Reykjavik, Iceland"},{"name":"Department of Medical Oncology, Landspitali University Hospital, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Gudbjartsson","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland"},{"name":"Faculty of Medicine, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8310-7951","authenticated-orcid":false,"given":"Halla","family":"Vidarsdottir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Iceland, Reykjavik, Iceland"},{"name":"Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Xiao G Wang X Xu Z et al. Lung-specific metastasis: the coevolution of tumor cells and lung microenvironment. Mol Cancer 2025;24:118. https:doi.org\/10.1186\/s12943-025-02318-6","DOI":"10.1186\/s12943-025-02318-6"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Gonzalez M Brunelli A Szanto Z et al. Report from the European Society of Thoracic Surgeons database 2019: current surgical practice and perioperative outcomes of pulmonary metastasectomy. Eur J Cardiothorac Surg 2021;59: 996\u20131003. https:\/\/doi.org\/10.1093\/ejcts\/ezaa405","DOI":"10.1093\/ejcts\/ezaa405"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Yuste M Cassivi S Paleru C. Pulmonary metastasectomy in breast cancer. J Thorac Oncol 2010;5:S170\u2013S171. https:\/\/doi.org\/10.1097\/jto.0b013e3181dcf933","DOI":"10.1097\/JTO.0b013e3181dcf933"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Petrella F Danuzzo F Sibilia MC et al. Colorectal cancer pulmonary metastasectomy: when why and how. Cancers (Basel) 2024;16:1408. https:\/\/doi.org\/10.3390\/cancers16071408","DOI":"10.3390\/cancers16071408"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Erhunmwunsee L Tong BC. Preoperative evaluation and indications for pulmonary metastasectomy. Thorac Surg Clin 2016;26:7\u201312. https:\/\/doi.org\/10.1016\/j.thorsurg.2015.09.002","DOI":"10.1016\/j.thorsurg.2015.09.002"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Chen H Stoltzfus KC Lehrer EJ et al. The epidemiology of lung metastases. Front Med (Lausanne) 2021;8:723396. https:\/\/doi.org\/10.3389\/fmed.2021.723396","DOI":"10.3389\/fmed.2021.723396"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"Cheung FP-Y Alam NZ Wright GM. The past present and future of pulmonary metastasectomy: a review article. Ann Thorac Cardiovasc Surg 2019;25:129\u2013141. https:\/\/doi.org\/10.5761\/atcs.ra.18-00229","DOI":"10.5761\/atcs.ra.18-00229"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Markowiak T Dakkak B Loch E et al. Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival. J Cardiothorac Surg 2021; 16:84. https:\/\/doi.org\/10.1186\/s13019-021-01460-8","DOI":"10.1186\/s13019-021-01460-8"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Treasure T Williams NR. Lung metastasectomy for colorectal cancer in the PulMiCC randomised controlled trial. Lancet Reg Health Eur 2021;3:100080. https:\/\/doi.org\/10.1016\/j.lanepe.2021.100080","DOI":"10.1016\/j.lanepe.2021.100080"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Treasure T Farewell V Macbeth F et al. Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): a multicentre randomised clinical trial. Trials 2019;20:718. https:\/\/doi.org\/10.1186\/s13063-019-3837-y","DOI":"10.1186\/s13063-019-3837-y"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Milosevic M Edwards J Tsang D et al. Pulmonary metastasectomy in colorectal cancer: updated analysis of 93 randomized patients\u2013control survival is much better than previously assumed. Colorectal Dis 2020;22(10):1314\u20131324. https:\/\/doi.org\/10.1111\/codi.15113","DOI":"10.1111\/codi.15113"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Nakajima J Iida T Okumura S et al. Recent improvement of survival prognosis after pulmonary metastasectomy and advanced chemotherapy for patients with colorectal cancer. Eur J Cardiothorac Surg 2017;51:869\u2013873. https:\/\/doi.org\/10.1093\/ejcts\/ezw401","DOI":"10.1093\/ejcts\/ezw401"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","unstructured":"Bartlett EK Simmons KD Wachtel H et al. The rise in metastasectomy across cancer types over the past decade. Cancer 2015;121:747\u2013757. https:\/\/doi.org\/10.1002\/cncr.29134","DOI":"10.1002\/cncr.29134"},{"key":"e_1_3_2_15_2","doi-asserted-by":"crossref","unstructured":"Higashiyama M Tokunaga T Nakagiri T et al. Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection. Gen Thorac Cardiovasc Surg 2015; 63(6):320\u2013330. https:\/\/doi.org\/10.1007\/s11748-015-0544-9","DOI":"10.1007\/s11748-015-0544-9"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","unstructured":"Karjula TNA Mustonen O Puro I et al. Results of intention-to-treat pulmonary metastasectomies in northern Finland revealing significant number of new lung primary carcinomas: time to move on from wedge resections? J Thorac Dis 2023;15:3319\u20133329. https:\/\/doi.org\/10.21037\/jtd-22-1647","DOI":"10.21037\/jtd-22-1647"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"Sund M Yaqub S. The expanding role of surgery in metastatic disease: a modern perspective. Scand J Surg 2025;114(2):113\u2013114. https:\/\/doi.org\/10.1177\/14574969251347342","DOI":"10.1177\/14574969251347342"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.21037\/shc.2019.12.04"},{"key":"e_1_3_2_19_2","doi-asserted-by":"crossref","unstructured":"Kondo H Okumura T Ohde Y et al. Surgical treatment for metastatic malignancies. Pulmonary metastasis: indications and outcomes. Int J Clin Oncol 2005;10(2):81\u201385. https:\/\/doi.org\/10.1007\/s10147-004-0472-7","DOI":"10.1007\/s10147-004-0472-7"},{"key":"e_1_3_2_20_2","doi-asserted-by":"crossref","unstructured":"Rusch VW. Pulmonary metastasectomy. Current indications. Chest 1995;107:322S\u2013331S. https:\/\/doi.org\/10.1378\/chest.107.6_supplement.322s","DOI":"10.1378\/chest.107.6_Supplement.322S"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","unstructured":"Prisciandaro E Bertolaccini L Fieuws S et al. Multicentre retrospective analysis on pulmonary metastasectomy: an European perspective. Eur J Cardiothorac Surg 2024;65: ezae141. https:\/\/doi.org\/10.1093\/ejcts\/ezae141","DOI":"10.1093\/ejcts\/ezae224"},{"key":"e_1_3_2_22_2","doi-asserted-by":"crossref","unstructured":"Chang CH Chiang XH Lin MW et al. Outcome and survival analysis of pulmonary metastasectomy for primary sarcoma with pulmonary metastases. Front Surg 2024;11:1470784. https:\/\/doi.org\/10.3389\/fsurg.2024.1470784","DOI":"10.3389\/fsurg.2024.1470784"},{"key":"e_1_3_2_23_2","doi-asserted-by":"crossref","unstructured":"Pastorino U Buyse M Friedel G et al. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997;113(1):37\u201349. https:\/\/doi.org\/10.1016\/s0022-5223(97)70397-0","DOI":"10.1016\/S0022-5223(97)70397-0"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1293602"},{"key":"e_1_3_2_25_2","doi-asserted-by":"crossref","unstructured":"Seyrek Y Cansever L Bedirhan MA. Which factors significantly reduce long-term survival after pulmonary metastasectomy? Curr Thorac Surg 2021;6:1\u20136. https:\/\/doi.org\/10.26663\/cts.2021.0003","DOI":"10.26663\/cts.2021.0003"},{"key":"e_1_3_2_26_2","doi-asserted-by":"crossref","unstructured":"Treasure T Milo\u0161evi\u0107 M Fiorentino F et al. Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Table 1. Thorax 2014;69:946\u2013949. https:\/\/doi.org\/10.1136\/thoraxjnl-2013-204528","DOI":"10.1136\/thoraxjnl-2013-204528"},{"key":"e_1_3_2_27_2","doi-asserted-by":"crossref","unstructured":"Yamamoto Y Kanzaki R Kanou T et al. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol 2019;24(7):863\u2013870. https:\/\/doi.org\/10.1007\/s10147-019-01422-0","DOI":"10.1007\/s10147-019-01422-0"},{"key":"e_1_3_2_28_2","doi-asserted-by":"crossref","unstructured":"Dudek W Schreiner W Mykoliuk I et al. Pulmonary metastasectomy for sarcoma\u2014survival and prognostic analysis. J Thorac Dis 2019;11(8):3369\u20133376. https:\/\/doi.org\/10.21037\/jtd.2019.08.10","DOI":"10.21037\/jtd.2019.08.10"},{"key":"e_1_3_2_29_2","doi-asserted-by":"crossref","unstructured":"Meacci E Nachira D Congedo MT et al. Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience. J Thorac Dis 2017; 9(suppl. 12):S1267\u2013S1272. https:\/\/doi.org\/10.21037\/jtd.2017.05.04","DOI":"10.21037\/jtd.2017.05.04"},{"key":"e_1_3_2_30_2","doi-asserted-by":"crossref","unstructured":"Proch\u00e1zkov\u00e1 K Vodi\u010dka J Fichtl J et al. Outcomes for patients after resection of pulmonary metastases from clear cell renal cell carcinoma: 18 years of experience. Urol Int 2019;103(3):297\u2013302. https:\/\/doi.org\/10.1159\/000502493","DOI":"10.1159\/000502493"},{"key":"e_1_3_2_31_2","doi-asserted-by":"crossref","unstructured":"Meri Abad M Avila Andrade C Cunquero Tomas AJ et al. Impact on survival of pulmonary metastasectomy in colorectal cancer. Ann Oncol 2017;28:x47. https:\/\/doi.org\/10.1093\/annonc\/mdx659.015","DOI":"10.1093\/annonc\/mdx659.015"},{"key":"e_1_3_2_32_2","doi-asserted-by":"crossref","unstructured":"Al-Ameri M Persson M Bergman P et al. Surgery for pulmonary metastases from colorectal cancer: survival and prognostic factors. J Thorac Dis 2018;10(6):3372\u20133380. https:\/\/doi.org\/10.21037\/jtd.2018.05.120","DOI":"10.21037\/jtd.2018.05.120"}],"container-title":["Scandinavian Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14574969261468491","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/14574969261468491","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14574969261468491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:47:17Z","timestamp":1787993237000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/14574969261468491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":31,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/14574969261468491"],"URL":"https:\/\/doi.org\/10.1177\/14574969261468491","relation":{},"ISSN":["1457-4969","1799-7267"],"issn-type":[{"value":"1457-4969","type":"print"},{"value":"1799-7267","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}