Surgical Treatment of Extrapulmonary Oligometastatic Non-small Cell Lung Cancer

The prognosis of metastatic non-small cell lung cancer (NSCLC) is poor, and platinum-based chemotherapy improves the median survival for only a few months. A subgroup of patients with oligometastatic disease may benefit from surgical resection, but only very limited data are available to date. We conducted a retrospective review of all patients with synchronous extrapulmonary oligometastatic NSCLC undergoing surgical resection in our department. Data regarding medical history, histology, number of metastases, and survival status were extracted from the medical database of the University Medical Center, Freiburg. Fifty-six patients underwent surgical resection for oligometastatic lung cancer. Five patients were lost during follow-up and therefore censored. One patient died perioperatively due to acute respiratory distress syndrome. The remaining 50 patients had an overall median survival time of 14.6 months. Analyzing the influence of metastatic site, we found a median overall survival of 23.4 months for patients with soft tissue metastasis, 16.7 months for patients with brain metastasis, 9.5 months for patients with adrenal gland involvement, and only 4.3 months for patients with bone metastasis (p < 0.005). Upon multivariate analysis, bone metastasis was the only significant parameter influencing median overall survival (p < 0.004). Based on our data, we conclude that an aggressive surgical approach for oligometastatic NSCLC can be performed with acceptable mortality and morbidity. In this rare constellation, surgical therapy may be an option in selected cases.