The role of surgery in lung metastases

Aims:To evaluate the efficacy of pulmonary metastasectomy in 93 patients with lung metastases (LM) operated on from 1983 to 1997.Methods:We assessed: location and histological diagnosis of the primary tumour (PT); the extent of pulmonary resection; and disease-free interval (DFI). Survival analysis was undertaken using the Kaplan–Meier method.Results:Surgical complications occurred in eight (9%) patients; two (3%) died in hospital; seven (8%) were operated again because of further LM. In the whole patient group the average survival after metastasectomy was 40 months (median 22 months). The actuarial survival was 44% at 3 years and 35% at 5 years. With metastasectomy we achieved an overall survival after treatment of PT of 87 months (median 58 months). The actuarial survival was 58% at 5 years and 38% at 10 years. The average time between the treatment of PT and metastasectomy DFI was 4 years (median 41 months). Patients with a DFI of more than 2 years tended to live longer (P=0.086). There were 23 patients with non-epithelial and 70 patients with epithelial tumours. Their DFIs were similar (mean 47, median 34 months for non-epithelial and mean 51, median 29 months for epithelial tumours). Of patients with non-epithelial tumours, 38% survived for 5 years and their survival curves were similar. In the group of tumours with the most frequent location, the results of metastasectomy did not differ considerably: 5 year survival rates of 20% for patients with kidney tumours, 28% for colorectal cancer, 30% for soft-tissue sarcoma, 28% for skin melanoma and 18% for breast cancer.Conclusions:Lung metastasectomy seems to be a safe and efficient method of treatment even for patients who show further metastases. According to our study it seems that, except for LM of breast carcinoma (which has a slightly worse prognosis), the results of surgical resection are not dependent on either the location or the histological pattern of the PT. For this reason patients indicated for operation can be selected according to similar criteria.