Objective : To evaluate survival results after resection in patients with metachronous thoracic metastatic disease and to identify prognostic factors of survival.
Methods : From 1990 to 2002, we retrospectively studied 128 procedures performed on 99 patients (3-84 y.o.). Tumor histology was epithelial in 49 patients, sarcoma in 22 patients, teratomas and melanomas in 6 and 4 patients respectively. Other histology was found in the remaining 19 patients. Operative approaches included 108 muscle-sparing lateral thoracotomies, 8 sternotomies and 10 VATS. There were 92 parenchymal resections, 16 chest wall resections and 11 parenchymal resections extended to the chest wall. The mean number of metastasis resected per patient was 2.45 (range 1-13).
Resection was complete (R0) in 73 patients (74%), and microscopically incomplete (R1) in 12 patients (12%) and macroscopically incomplete (R2) in 14 patients (14%).
Results : Follow-up was 98% complete, with a mean of 37 months (range 1-136). In-hospital mortality was 2.3% (3 patients) and major morbidity 5.5% (7 patients). Median survival was 38 months. Overall, the actuarial survival at 1, 3, and 5 years were 86%, 52% and 40%, respectively. No survival difference was observed according to the primary tumor. Although 3-year survival was improved in complete resections (52% vs 41.5%), this difference was not significant (p = .25 ).
Conclusion : This study supports our current aggressive approach to metachronous metastatic thoracic disease. Indeed, patient survival is improved while a low mortality and morbidity is achieved. The most beneficial impact on long-term survival seems to be correlated to the completeness of the surgery.