Outcome after pulmonary metastasectomy: analysis of 5 years consecutive surgical resections 2002-2006

In this study, we analyze the results of management of pulmonary metastases in 5 years consecutive operations at our institution. We aim to define the patients who are most likely to benefit from surgery by investigating long-term survival and prognostic factors associated with prolonged survival.

The data on all consecutive patients between 2002 and 2006 were reviewed retrospectively. One hundred seventy-eight patients underwent 256 surgical resections for suspected pulmonary metastases from different primary malignancies. Prognostic factors analyzed included age, sex, surgical approach, surgical resection, number of metastases, distribution of metastases, disease-free interval, presence of synchronous metastases, recurrence of disease, prior liver resection (colorectal cancer), and tumor histology (sarcomas).

Complete resection was achieved in 248 cases (96.8%). The mean follow-up was 61.6 months. Five-year survival with respect to primary malignancy was colorectal carcinoma (50.3%), sarcoma (21.7%), malignant melanoma (25.0%), renal cell carcinoma (51.4%), and miscellaneous malignancies (50.0%). Of the prognostic factors analyzed by univariate analysis, none was found to be significant in all the different groups of cancers.

Pulmonary metastasectomy is a safe and effective treatment that may be associated with prolonged survival in highly selected patients. Low morbidity and mortality rates in contrast with the lack of any other effective treatment justify the aggressive approach of surgery. Thoracoscopic resection is a valid option in selected patients. In case of recurrence of pulmonary disease and if the patient fulfils the initial criteria for pulmonary metastasectomy, repeat surgery should be performed. Solid prognostic factors still need to be established.