Objective : A retrospective analysis of all pulmonary resections for lung metastases between 1990 and 2000 to assess long-term results.
Methods : Fifty-six patients were accrued for analysis. All underwent complete resection. The primary tumor was epithelial in 25 cases, sarcoma in 15, germ cell in 11 and melanoma in 5. Median follow-up was 29 months for non-germ cell tumors, while not reached for germ cell tumors. Analysis was performed by Kaplan-Meier estimates of survival and multivariate Cox model.
Results : Perioperative mortality was 1,4% (1/73 procedures). Actuarial survival after metastasectomy for non-germ cell tumors was 25% at 5 years. Patients with germ cell tumors had the best survival (76% at 5 years). This was significantly better compared to sarcoma (p=0.03) and melanoma (p=0.009). Survival according to DFI, number of metastases resected or a prior extrapulmonary resection was not statistically significant different at 5 years. The long-term outcome of patients who were treated by a second metastasectomy was remarkably good: 46% survival at 5-years, compared with 16% for patients having had one single operation (p=0.004). Patients having a pneumonectomy did not worse than patients with a lesser resection. In sarcomas and epitheliomas, intrathoracic relapse accounted for 57% and 50% of all recurrences. Multivariate analysis showed a better prognosis for patients with germ cell tumors.
Conclusion : These results confirm that lung metastasectomy is a safe and potentially curative procedure. Repeated salvage operations can result in a long-term survival. The high number of intrathoracic recurrences for sarcomas and epitheliomas shows the need for adjuvant therapies.