Results and prognostic factors after resection of pulmonary metastases

Abstract

One hundred and fifty-nine thoracotomies were performed in 122 patientswith pulmonary metastases. The patients' ages ranged from 2 to 76 years,and 13 patients were younger than 18 years. The primary tumour wascarcinoma in 83 cases, sarcoma in 29 cases and melanoma in 10 cases. Theprimary tumour in children was osteogenic sarcoma (6 patients), Ewing'ssarcoma (2 patients) and Wilms' tumour (2 patients). With a minimumfollow-up of 2 years, an actuarial 5-year survival rate of 38% was observedfor carcinoma and 28% for sarcoma. Four of the children surviveddisease-free for 3 years or more after pulmonary metastasectomy. Theprimary tumour in these cases was osteogenic sarcoma and Ewing's sarcoma. Astatistically significant difference in survival was found between thegroups of carcinoma and sarcoma, but the prognosis for melanoma patientswas markedly worse. In carcinoma patients the main prognostic factor wasthe duration of the disease- free interval. The actuarial postthoracotomysurvival in patients with osteogenic sarcomas was 31% at 5 years, and 18%at 5 years in soft- tissue sarcomas. The size of the lesions, activity anddisease-free interval correlated with survival in the osteogenic sarcomagroup, and the number of lesions in the soft-tissue sarcoma group. Anaggressive surgical approach towards pulmonary metastatic disease thusappears to be justified.