Pulmonary metastasectomy—A single institution experience

Abstract

18505 Background: Resection of pulmonary metastases is a common procedure as part of the multidisciplinary management of a patient with metastatic disease confined to the lung. It is being utilized in a range of cancers including soft tissue sarcoma, renal cell carcinoma and colorectal cancer. Methods: We present twenty-one cases of metastatic cancer treated with pulmonary metastasectomy, identified on retrospective analysis of case files, over a period from 1994 to 2007. Results: Twenty-one cases were identified in total. The primary lesion was colorectal adenocarcinoma in 5 cases, head and neck squamous cell carcinoma in 5 cases, osteogenic sarcoma in 3 cases, melanoma in 2 cases, uterine myosarcoma in 2 cases, synovial sarcoma in 2 cases, adenocarcinoma of the ampulla and in 1 case and non-seminomatous germ cell tumor in 1 case. 57% of patients were female. The median disease free interval, from initial diagnosis to development of pulmonary metastases, was 34 months (range 7 mths to 11yrs). The median age at surgery was 53 yrs (range 20-75 yrs). 6 patients underwent repeat pulmonary metastasectomy for recurrent pulmonary disease. Two patients had both liver and pulmonary metastases resected. The median follow-up from date of pulmonary resection was 36 months (range 1 month-104 months). Three years post metastasectomy, 55% of patients were alive. Conclusions: This series illustrates the evolving role of pulmonary metastasectomy in the management of patients with metastatic cancer. Advances in imaging have led to the identification of small, potentially resectable lesions. New systemic therapies have led to down-staging of lesions, thus, pulmonary metastasectomy is increasingly an option in a broadening range of cancers. A survival advantage for pulmonary metastasectomy has been shown in several published series. However, there are no randomized prospective trials examining the role of metastasectomy and this remains a procedure in highly selected patients in a multi disciplinary setting. No significant financial relationships to disclose.