Results and prognostic factors after resection of pulmonary metastases

One hundred and fifty-nine thoracotomies were performed in 122 patients with pulmonary metastases. The patients' ages ranged from 2 to 76 years, and 13 patients were younger than 18 years. The primary tumour was carcinoma in 83 cases, sarcoma in 29 cases and melanoma in 10 cases. The primary tumour in children was osteogenic sarcoma (6 patients), Ewing's sarcoma (2 patients) and Wilms' tumour (2 patients). With a minimum follow-up of 2 years, an actuarial 5-year survival rate of 38% was observed for carcinoma and 28% for sarcoma. Four of the children survived disease-free for 3 years or more after pulmonary metastasectomy. The primary tumour in these cases was osteogenic sarcoma and Ewing's sarcoma. A statistically significant difference in survival was found between the groups of carcinoma and sarcoma, but the prognosis for melanoma patients was markedly worse. In carcinoma patients the main prognostic factor was the duration of the disease-free interval. The actuarial postthoracotomy survival in patients with osteogenic sarcomas was 31% at 5 years, and 18% at 5 years in soft-tissue sarcomas. The size of the lesions, activity and disease-free interval correlated with survival in the osteogenic sarcoma group, and the number of lesions in the soft-tissue sarcoma group. An aggressive surgical approach towards pulmonary metastatic disease thus appears to be justified.