Resection of pulmonary metastasis of non-small cell lung cancer

Management of pulmonary metastasis of non-small cell lung cancer (NSCLC) remains controversial. We reviewed our surgical treatment for pulmonary metastasis of NSCLC.

Seventy-six patients with pulmonary metastasis of NSCLC underwent pulmonary resections in two institutes during the past 10 years. Eighteen patients with simultaneous same lobe metastasis as the primary lesion underwent mostly lobectomies. Sixteen patients with simultaneous different lobe metastasis underwent combined margin-free resections. Forty-nine pulmonary metastasectomies were performed in 42 patients with recurrent lung cancer. Overall survival and disease-free survival in each group were examined, and factors affecting survivals were investigated.

In the patients with the same lobe metastasis 5-year survival was 79.6%, and median and 5-year disease-free survivals were 39.1 months and 41.3%. In the patients with simultaneous different lobe metastasis median survival and 5-year survival were 37.7 months and 30.7%, and median and 5-year disease-free survivals were 13.3 months and 12.5%, respectively. Multiple pulmonary metastasis and mediastinal node metastasis were identified as significant factors affecting survivals. In the patients with recurrent pulmonary metastasis median survival and 5-year survival were 40.0 months and 34.8%, and median and 5-year disease-free survivals were 23.7 months and 14.4%, respectively. Node metastasis, higher age, and shorter interval from the prior resection were identified as significant factors affecting survivals.

These findings suggest that the simultaneous same lobe metastasis is under the same indication for the primary lesion, and that the simultaneous different lobe metastasis and recurrent pulmonary metastasis should be removed in selected patients.