Metastasectomy for synchronous solitary non-small cell lung cancer metastases

Surgical treatment of patients with limited metastatic lesions from non-small cell lung cancer (NSCLC) remains controversial; however, reports suggest that a subset of patients may benefit from complete resection including metastasectomy.

Between 1997 and 2009, 99 patients underwent complete solitary synchronous NSCLC metastasis resection in a single center. Only patients who met the potentially curative operation criteria (ie, primary NSCLC and metastasis resection of a solitary pulmonary or solitary extrapulmonary metastases) were included for retrospective analyses within this study.

The overall 5-year survival rate was 38%. A significantly longer survival was observed in patients without mediastinal (N2 or N3) lymph node involvement (median, 50.0 months) compared with patients who had mediastinal lymph node metastases (median, 19.0 months survival; p=0.015). In patients with a solitary metastasis in the ipsilateral (not ipsilobar) or contralateral lung, we observed a 5-year survival rate of 48.5%, whereas the rate was 23.6% in patients with extrapulmonary metastases (p=0.006). In univariate analysis, a trend for a more favorable long-term survival rate was observed for patients with a histologic grade of G1 or G2 versus G3 primary NSCLC (p=0.058).

We conclude that metastasectomy for synchronous oligometastatic disease in NSCLC can be performed in selected patients. It appears reasonable that such patients should be considered as surgical candidates if mediastinal lymph node involvement is excluded.