Lung metastasectomy: long-term outcomes in an 18-year cohort from a single center

Lung metastasectomy is an area of interest and controversy in surgical oncology. Most of the available evidence derives from small cohorts with short follow-up. The aim of this study was to evaluate the oncologic outcomes in an 18-year cohort from a single center. We retrospectively reviewed 398 patients with several malignancies who underwent lung metastasectomy between January 1990 and December 2008. Demographic, clinical, and surgical variables were evaluated. Uni- and multivariate analyses were performed to identify factors associated with overall survival (OS). Mean follow-up was 20 months. Wedge resection was performed in 297 cases and 101 required anatomic resections. In 303 patients the disease-free interval (DFI) was >6 months meanwhile 95 patients had a DFI ≤6 months. Complete resection was achieved in 351 patients (88.2%). Median OS for all patients was 81.9 months (95% CI, 36.9-126.9). On multivariate analysis, factors associated with a poor overall survival were DFI <6 months (HR, 1.74; 95% CI, 1.24-2.4; p=0.001) and incomplete resection (HR, 1.58 95% CI, 1.01-2.5; p=0.0047). Independent prognostic factors associated with better survival were DFI >6 months and complete resection. Size and number of metastases as well as re-do metastasectomy were not associated with worse survival.