Pulmonary metastasectomy in Iceland: Long-term nationwide trends and outcomes

Pulmonary metastases are generally associated with poor prognosis, and only a selected subset of patients undergo surgery. However, population-level data on outcomes remain limited. This study aimed to evaluate temporal trends and outcomes of pulmonary metastasectomy (PM) in a nationwide cohort over more than two decades.

This retrospective cohort study included all patients who underwent PMs in Iceland between 2001 and 2021. The study period was divided into three 7-year intervals for comparison. Survival was evaluated from the first PM using the Kaplan-Meier analysis, and prognostic factors were assessed using multivariable Cox regression.

A total of 179 PMs were performed, with procedure volume increasing significantly during the final study period. The median age at the first PM was 62 years, and 54% of patients were male. The most common indication was metastatic colorectal carcinoma (39.3%), followed by renal cell carcinoma (16.4%) and sarcoma (10%). Median follow-up was 52 months. Early major postoperative complications occurred in 2.2% of cases, with a 30-day mortality rate of 1.1%. Five-year overall survival was 49.7%, and 55.5%, 60.9%, and 35.7% for colorectal carcinoma, renal cell carcinoma, and sarcoma tumor subtypes, respectively. Five-year overall survival increased significantly from 31% to 55% across the first and last 7-year periods. In addition to sarcoma histology and an operation in the first period, negative prognostic factors included advanced age, a greater number of metastases, and a prior extrathoracic metastasectomy.

The use of PM increased over time and was accompanied by improved long-term survival, likely reflecting advances in systemic therapy, imaging, and patient selection. The procedure had a low rate of major complications, and 5-year survival rates were comparable to those reported in international data.