Metastatic lung tumors and extended indications for surgery

From 1973 to 1989, 110 thoracotomies for metastatic lung tumors were done on 85 patients, in our institution. The overall actuarial five-year survival rate was 31%. The five-year survival rate for carcinoma was 40% and for sarcoma was 11% (less than 0.05). A favorable outcome was obtained in the group with primary tumors of the breast, head-neck, and chorion. The outcome for patients with bone and soft tissue tumors was poor. The significant predictors of a better long-term survival for metastatic lung tumors were disease-free interval (DFI) greater than 12 months, tumor size less than or equal to 30 mm in diameter, and tumor doubling time (TDT) greater than 40 days (p less than 0.05). The number of nodules and the laterality of the sites of recurrence did not relate to survival time. Of 22 patients undergoing regional lymph node dissection, seven (32%) had positive nodes. Even in cases of a recurrent pulmonary metastasis, the three-year survival in those with multiple thoracotomies was 16%. We wish to draw attention to the finding that a prolonged survival time can be achieved for patients undergoing regional lymph node dissection or even repeated resections for a recurrent pulmonary metastases.