Results of pulmonary resection for metastatic lesions

We reviewed the role pulmonary resection for metastatic pulmonary lesions in our institution. Over a 22 year period, 142 patients underwent 153 thoracotomies. The operative mortality was 0.7%. Complete follow-up was obtained on 140 hospital survivors (99.3%). The actuarial 5 year survival rate for carcinoma was 24% (70% confidence limit 0% to 52%) and for sarcoma was 29% (70% confidence limit 0% to 61%). The survival rate to the end of the follow-up for patients with short disease-free intervals (less than 3 months) was 30%; with free intervals of 3 to 30 months, the survival rate was 27%; with long intervals (greater than 30 months), it was 24% (p = 0.8). Six of 29 lobectomy or pneumonectomy specimens has secondary metastases in the regional nodes, but actuarial 5 year survival rates following lobectomy, pneumonectomy, or segmental or wedge excision were not statistically different. Long-term follow-up revealed an overall survival rate of 26%, which was not influenced by tumor histology, disease-free interval, or extent of pulmonary excision. In view of these findings, we continue to advocate conservative excision of pulmonary metastases when the primary tumor is controlled and other organ systems are not involved, regardless of the tumor histology or the disease-free interval.