P2.04-053 Surgery of Multiple Lung Metastases in Patients with Sarcomas and Epithelial Tumors: Topic: Esophageal Cancer and Other Malignancies

Abstract

Pulmonary metastases are the most common recurrences of bone or soft tissue sarcomas and epithelial tumors. A role of surgical treatment in management of multiple lung metastases has not been well-established. We aimed to assess the rates of early post-operational complications and survival outcomes after pulmonary resection for multiple metastases. A series of patients who underwent pulmonary resections for multiple metastases (≥4) between January 2004 and December 2015 in Medical Radiological Research Center (Obninsk, Russia) were retrospectively evaluated. Perioperative clinical and histopathological data and long-time survival were analyzed. Forty seven patients who received surgical treatment for multiple lung metastases were included in the analysis (24 males). Mean age was 44 years (range 18-70). Twenty nine patients had primary diagnosis of bone or soft tissue sarcoma and 18 patients had epithelial tumors. All subjects received radical surgical treatment of primary cancer in combination with radiation therapy (in 25 subjects) or chemotherapy (in 35 subjects). The mean time to detection of lung metastasis was 15 months. Bilateral lung involvement was identified in 32 patients. Eighty four operations were performed (76 atypical resections, 6 lobectomy, 1 segmentectomy and 1 pneumonectomy). In average, 6 lesions were removed (range 4-103). Nd:YAG laser (length of wave 1318nm) used in 44 operations and electrocautery in 32 cases. In case of bilateral lesions surgical interventions were performed 4-6 weeks apart. In 4 patients metastatic process was not confirmed (tuberculosis, fibrosis and necrosis). Early postoperative complications were observed in 7 subjects (5 cases of pneumothorax, durable lymphorrhea and phlebothrombosis. The rate of postoperative complications were similar when laser (3/44) or electrocautery (4/32) were used. There was no mortality within 30 days post operation. Mean survival time was 22.5 months (range 3-149 months). The duration of survival depends on histological type of primary tumor (21 months for patients with bone or soft tissue sarcoma and 46 months for patients with epithelial tumors). The survival time appeared to be shorter for patients with bilateral process than unilateral but the difference was not statistically significant (23 and 48 months, respectively, p=0.25). The development of distant metastases is associated with extremely poor survival of patients with sarcomas and epithelial tumors. Based on our observation we suggest that some patients with multiple lung metastases can benefit from aggressive surgical treatment. The controlled, prospective, large-scale clinical studies are required to further assess impact of surgical treatment on survival of these patients.