Recurrent Pulmonary Metastases Research Articles

Pulmonary Metastasectomy after Immune Checkpoint Inhibitors in Renal Cell Carcinoma.

The management of oligometastatic renal cell carcinoma with pulmonary metastases is controversial and occasionally requires multimodality management, including salvage pulmonary metastasectomy after immune checkpoint inhibitors (ICIs). However, limited data are available on these patients. We describe a case series of three consecutive patients who underwent salvage pulmonary metastasectomy after ICIs for oligometastatic renal cell carcinoma and discussed the important characteristics of these patients. After salvage pulmonary metastasectomy, none of the patients had recurrent pulmonary metastases, although one of them developed a brain metastasis postoperatively. Our case series suggests that salvage pulmonary metastasectomy after ICIs may control pulmonary metastases in carefully selected patients with oligometastatic renal cell carcinoma, although the management of extrapulmonary metastases may be required after salvage pulmonary metastasectomy.

Pulmonary metastasectomy after immune checkpoint inhibitors in malignant melanoma.

The management of malignant melanoma with pulmonary metastases is controversial and occasionally requires multimodality management, including pulmonary metastasectomy after immune checkpoint inhibitors (ICIs). However, limited data are available on these patients. We described a case series of three consecutive patients who underwent pulmonary metastasectomy after ICIs for malignant melanoma and discussed the important characteristics of these patients. After pulmonary metastasectomy, none of the patients had recurrent pulmonary metastases, although extrapulmonary metastases were developed. Our case series suggests that pulmonary metastasectomy after ICIs may control pulmonary metastases in carefully selected patients with malignant melanoma.

Outcome of Repeated Resection of Pulmonary Metastases for Renal Cell Cancer.

To date, many studies investigated results and prognostic factors of pulmonary metastasectomy (PM) in renal cell cancer (RCC). However, reports concerning repeated resection for patients with recurrent pulmonary metastases (RPM) are limited. In this study, we analyzed safety, efficacy, and prognostic factors for survival after PM focusing on RPM for RCC. Clinical, operative, and follow-up data of patients who underwent PM or RPM for RCC in our institution were retrospectively collected and correlated with each other from January 2005 to December 2019. Altogether 154 oncological pulmonary resections in curative intention as PM or RPM were performed in 82 and 26 patients. Postoperative complications were similar in both groups (n = 22 [26.8%] vs. 4 [15.4%], p = 0.2). Zero mortality was documented up to the 30th postoperative day. RPM was not associated with decreased 5-year-survival compared with PM (66.2 vs. 57,9%, p = 0.5). Patients who underwent RPM for recurrent lung metastases had a better overall survival in comparison with the other treatments including chemotherapy, radiotherapy, immunotherapy, and best supportive care (p = 0.04). In the multivariate analysis, disease-free survival was identified as an independent prognostic factor for survival (hazard ratio: 0.969, 0.941-0.999, p = 0.04). RPM is a safe and feasible procedure. The resection of recurrent lung metastases shows to prolong survival in comparison with the other therapeutic options for selected patients with RCC.

A case of repeat resection for recurrent pulmonary metastasis from sebaceous gland carcinoma

BackgroundSebaceous gland carcinoma (SGC) of the eyelid is an aggressive malignant eyelid tumor, and it can metastasize to the regional lymph nodes and distant organs. There have been only a few reported cases of patients who underwent pulmonary metastasectomy for metastatic SGC. We herein report a patient who underwent repeat pulmonary metastasectomies for recurrent pulmonary metastases from SGC.Case presentationBilateral small pulmonary nodules were detected in a 59-year-old woman with a history of eyelid SGC. She underwent wide wedge resection of the left lower lobe, and the disease was diagnosed as pulmonary metastases from SGC. Six months after the first pulmonary resection, CT showed that the nodules of right S2 and S10 had increased in size, and three small nodules had newly appeared in the right lung. The patient therefore underwent six wide wedge resections of the right lung through thoracotomy. After that, she underwent pulmonary metastasectomy 2 times. Ninety months after the first pulmonary resection, the patient is doing well without disease.ConclusionsGiven that a long-term survival was ultimately achieved in the present case, repeat pulmonary metastasectomy may be beneficial for recurrent pulmonary metastasis from SGC.

Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma.

The prognostic factors of pulmonary metastasectomy in patients with osteosarcoma and soft tissue sarcoma remain controversial. The purpose of our analysis was to explore the prognostic factors and outcomes of patients with osteosarcoma and soft tissue sarcoma who underwent pulmonary metastasectomy at our institution. We reviewed the data of 44 patients who underwent resection of pulmonary metastases from 1996 to 2016at our institution. The Kaplan-Meier method, log-rank test and multivariate Cox hazard model were used for comparison and survival analyses. There was no perioperative mortality. The median post-metastasectomy overall survival was 24.8 months, and the 5-year overall survival rate of all patients was 43.5%. The 5-year survival rate of the patients who underwent repeat thoracotomies was 60.0%. Incomplete resection, a largest tumor size > 2cm and a disease-free interval < 12months were associated with poor survival in multivariate analyses. Among eight patients, who underwent repeat pulmonary resection, two remain alive with no evidence of disease. These patients had the longest DFI and DFI-2 (time from first pulmonary metastasectomy to the diagnosis of recurrent pulmonary metastasis), respectively. The survival of patients with a relatively long disease-free interval, small tumor size and complete resection was favorable following the treatment of osteosarcoma and soft tissue sarcoma with pulmonary metastasectomy. Repeat pulmonary metastasectomies also provide favorable prognosis in select patients.

How many times 125I seed implantation brachytherapy can be repeated for pulmonary metastases: clinical efficacy and complications.

PurposeThe aim of the study was to determine how many times iodine-125 (125I) seed brachytherapy (ISB) for recurrent pulmonary metastases (RPM) can be done, and the clinical efficacy and complications of repeated ISB in RPM treatment.Material and methodsBetween September 2013 and August 2018, 18 patients with RPM, after conventional chemotherapy, radiotherapy, and trans-arterial chemoembolization, received CT-guided repeated ISB. Patients were followed up, and local control, survival, and post-operative complications were analyzed retrospectively. The Kaplan-Meier method was used for survival analyses.ResultsEighty-two metastases in 18 patients were treated with ISB, with 71 implantations (mean number of implantations per patient, 4; range, 3-8). The total number of implanted 125I seeds was 1,220 (mean number per patient, 68; minimum, 40; maximum, 110). The mean value of D90 for ISB was 138 Gy. Local control was 91.46%, 90.24%, and 89.02% at 1, 3, and 6 months after ISB, respectively. After repeated ISB, good local control was achieved, and all patients were discharged from hospital within 3 days. One month after, six metastases of large diameter were treated with ISB; computed tomography revealed level 1 radioactive injury to the lungs, but special treatment was not administered. Post-operative renal, hepatic, and vascular functions were normal.ConclusionsISB for RPM is safe and efficacious. RPM treatment seems not to be limited by number of times ISB could be repeated; at least up to 8 times for different sites of lung.

Clinical efficiency of repeated pulmonary metastasectomy in sarcoma patients with recurrent pulmonary metastasis: A meta-analysis.

Recurrent pulmonary metastasis is common in sarcoma patients following the first pulmonary metastasectomy. Repeated pulmonary metastasectomy (RPM) may be a possible treatment method, but it has several unfavorable aspects. The clinical efficiency of RPM has not been established, as previous studies have reached inconsistent results. Comprehensively literature searches were conducted in PubMed, Web of Science, Embase, and Cochrane Library. All eligible articles were included according to inclusion criteria. Then, a meta-analysis was conducted to clarify the clinical efficiency of RPM. A total of 9 articles with 464 patients were included. We found that sarcoma patients with recurrent pulmonary metastasis that underwent RPM had significantly better overall survival (hazard ratio = 0.59; 95% confidence interval, 0.44-0.81; P = 0.001). No significant publication bias was found. Sensitivity analysis showed the results were stable. Selected sarcoma patients with recurrent pulmonary metastasis following the first pulmonary metastasectomy could still benefit from RPM, despite its unfavorable aspects.

Repeat resection for recurrent pulmonary metastasis of colorectal cancer.

Resection of recurrent lung metastases from colorectal cancer is not completely investigated. We analyzed overall survival and prognosticators after metastasectomy. We retrospectively reviewed our database of 238 patients with lung metastases of colorectal cancer, undergoing metastasectomy with systematic lymph node dissection from 1999 to 2014. Lymph node metastases were found in 55 patients, and liver metastases were found in 79 patients. The 5- and 10-year survival rates for all patients were 48 and 32%. Of the 238 patients included in the study, 101 developed recurrent lung metastases (42.4%). Recurrence had no impact on survival (p=0.474). The 5- and 10-year survival rates from the beginning of recurrence for all patients with recurrence were 40 and 25%. Overall, 52 patients had been reoperated for recurrent lung metastases. 5-year survival for reoperated patients was 75% and significantly prolonged compared with nonreoperated patients (p<0.001). Also, survival from beginning of recurrence was significantly longer (p<0.001). Recurrence was more often detected in the case of multiple metastases (p=0.002) and atypical resections (p=0.029) at first metastasectomy. Lymph node metastases (p=0.084) and liver metastases (p=0.195) had no influence on recurrence. For reoperated patients, lower grading of the primary tumor was the only independent prognosticator for survival in multivariate analyses (p=0.044). Good long-term survival is achievable for patients with resectable recurrent lung metastases. Multiple metastases and atypical resection at first metastasectomy were associated with recurrent disease. Neither lymph node metastases nor liver metastases were significantly associated with recurrence. Lower grading of the primary tumor was the only independent prognosticator for survival. All in all, the factors that can be influenced by the surgeon are patient selection and R0 resection.

異時性残肝再発・肺転移切除後長期生存が得られている腫瘤形成型肝内胆管癌の1例

異時性残肝再発・肺転移切除後長期生存が得られている腫瘤形成型肝内胆管癌の1例

Relapsed hepatoblastoma confined to the lung is effectively treated with pulmonary metastasectomy

BackgroundIn children diagnosed with hepatoblastoma (HB), the lungs are the most common site of metastasis at both initial presentation and relapse. Previous studies have encouraged pulmonary metastasectomy to achieve a disease-free state after resection of the primary hepatic lesion. However, there is no consensus about how to manage recurrent pulmonary metastasis. ProcedureA retrospective, multi-institutional review was performed from 2005 to 2014 to identify HB patients ≤18years of age who had disease recurrence associated with pulmonary metastases alone. ResultsTen patients between the ages of 8 and 33months were identified. Pulmonary metastatic recurrence was detected by measuring alpha-fetoprotein (AFP) levels and/or with CT scans of the chest. All patients subsequently underwent pulmonary metastasectomy without post-operative complications. At last follow-up, 8 patients were alive and had normal AFP levels. The 8 survivors had a median follow-up from therapy completion of 18.5months. Two patients who presented with extrapulmonary recurrence subsequently died of treatment refractory disease. ConclusionsThis review supports surgical resection as a safe and, in the context of multimodal therapy, efficacious approach to manage HB patients who present with isolated pulmonary relapse.

Historical perspective on the introduction and use of chemotherapy for the treatment of osteosarcoma.

Chemotherapy for treatment of osteosarcoma was demonstrated to be effective in eradicating primary tumor and pulmonary metastases in the mid-twentieth century. The first agents that held promise were doxorubicin and high-dose methotrexate with leucovorin (citrovorin factor) in the mid-1970s. Since then, other agents that can eliminate or cause regression of tumor have been discovered: cis-diamminedichloroplatinum II (cisplatin) and the oxazaphosphorines ifosfamide and cyclophosphamide. Additional agents await further study to define their potential. The effective agents have been utilized in various combination regimens and have escalated the survival rate from <10 to 75 %. They have also enabled pulmonary metastectomy in patients with persistent and/or recurrent pulmonary metastases and tumor ablation and limb salvage in 80 % of newly diagnosed patients. Unfortunately, however, despite these impressive advances no change in survival expectancy of patients with osteosarcoma during the past 40 years has occurred. There have been no new chemotherapeutic agents effective in addressing disease that is resistant to current agents; the few that have been introduced await further study to substantiate their efficacy. This also includes attempts at alternate administration of chemotherapy (intra-arterial and inhalation therapy.) In this chapter, we provide an account of the sequential introduction of the chemotherapeutic agents, review the results of their application in selected regimens, and discuss the role of neoadjuvant chemotherapy.

Results of pulmonary metastasectomy for osteosarcoma in the pediatric age group.

10080 Background: Despite multimodal treatment concepts and complete surgical resection, prognosis in pediatric patients with pulmonary metastases from osteosarcoma has remained limited due to frequent relapse of disease. We investigated the results of an aggressive surgical approach. Methods: In a retrospective study, procedures and outcomes of pulmonary metastasectomy in the pediatric age group (up to 18 years) at our institution were analyzed over a period of 10 years (1999-2009). Resection of the primary osteogenic tumor and chemotherapy (CROSS-96-protocol and EURAMOS-1-protocol) were performed prior to thoracic surgery. Results: Forty-five pediatric patients (20 females) underwent pulmonary metastasectomies via sternotomy or sequential anterolateral thoracotomy at a mean age of 14 (6 -18) years. At primary surgery, a mean number of 7.9 (1 – 53) palpable suspicious lesions were resected per patient. Histo-pathological evaluation revealed 3.7 (0 – 40) metastases per patient. Mean total duration of surgery was 152 (46–323) minutes. Mean hospital stay was 10 days (3 – 33). In-hospital and 30-day mortality was 0%. The overall survival at 1 and 5 years was 97.8% and 77.3%, respectively. Mean disease-free-survival was 12.2 (3.2-38.0) months. In 19 (42.2 %) patients recurrent pulmonary metastases were detected and re-thoracotomies were required. Up to 7 procedures per patient were performed. Overall survival for patients undergoing more than one surgical procedure for recurrent lung metastases was not statistically different from survival in patients without relapse (p &gt; 0.05). Survival was significantly better in patients initially presenting with less than 10 metastases (85.3 % vs. 54.1 % at 5 years, p = 0.028). Conclusions: Complete pulmonary metastasectomies are essential in pediatric osteosarcoma patients with lung metastasis. Repeated resections for recurrent relapses improve survival and may allow for long-term event-free-survival.

Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma

Background The outcomes after repeat pulmonary resection for colorectal cancer (CRC) and the factors associated with the prognosis of these patients remain uncharacterized. Methods Data on 156 patients who underwent curative resection of pulmonary metastasis from CRC were reviewed. Repeat pulmonary resection was performed in 25 patients; the present study examined the outcomes and factors associated with prognosis after repeat pulmonary resection. Results The 5-year survival rate after the first pulmonary resection was 56.2%. A multivariate analysis identified a histological type other than well-differentiated adenocarcinoma, a high prethoracotomy serum carcinoembryonic antigen (CEA) level, and the presence of hilar or mediastinal lymph node metastasis as poor prognostic factors for the first pulmonary resection. The 5-year survival rate after repeat pulmonary resection was 42.1%. Hilar or mediastinal lymph node metastasis at the time of the repeat resection was significantly associated with poor survival. Conclusions Repeat pulmonary resection for metastatic CRC provides satisfactory outcomes. Hilar or mediastinal lymph node involvement is consistently associated with a poor prognosis after the first and repeat pulmonary resections.

Radiofrequency Ablation of Concomitant and Recurrent Pulmonary Metastases after Surgery for Colorectal Liver Metastases

To evaluate our experience of radiofrequency ablation (RFA) of pulmonary metastases in patients with resected colorectal liver metastases who had concomitant or recurrent pulmonary metastases. Clinical and treatment variables of patients undergoing RFA were collected, and their association with survival was examined. Survival analysis was performed by the Kaplan-Meier method. RFA was performed as concomitant sequential treatment of extrahepatic pulmonary metastases after hepatectomy in 19 patients (30%) and as salvage treatment for pulmonary recurrences after hepatectomy in 45 patients (70%). Patients undergoing sequential treatment had a median survival of 31 (95% confidence interval [CI] 21.8-40.6) months compared to 59 (95% CI 35.0-82.0) months in the salvage treatment group (P=0.142). The disease-free survival (DFS) was 9 (95% CI 1.0-18.8) months in the sequential treatment group and 16 (95% CI 8.1-23.1) months in the salvage treatment group (P=0.023). Liver metastases occurring within 12months of the primary tumor negatively influenced overall survival (OS) and DFS in the sequential treatment group (P=0.003 and P=0.091). Poorly differentiated tumor (P=0.001) was associated with a poorer OS, and prehepatectomy carcinoembryonic antigen>200ng/ml (P=0.017) and bilateral pulmonary metastases (P=0.030) were associated with a shorter DFS in the salvage treatment group. The DFS and OS of patients undergoing sequential RFA of extrahepatic pulmonary metastases after hepatectomy appeared shorter when compared to patients who underwent RFA as salvage treatment for pulmonary recurrences after hepatectomy. It nonetheless remains better than the historical results of chemotherapy alone and thus supports the use of RFA as an ablative technology to achieve tumor control.

Undifferentiated Pleomorphic Sarcoma (Malignant Fibrous Histiocytoma) of the Head in a Dog

A six year-old intact female miniature poodle was presented with a soft mass of the forehead region. Computed tomography identified generalized frontal bone loss and a large extracranial mass, which had a low attenuation area of hemorrhagic necrosis with septation and enhancement of solid components. In magnetic resonance imaging, the mass was isointense in T1-weighted images except its fluid parts and hyperintense in T2-weighted images with lobulated by low-signal septa. Surgery was performed to remove the mass, and histopathologic examination revealed that the mass was consistent with undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). The dog died from the rapidly recurrent mass and severe pulmonary metastasis.

Tumor Infiltrated Hilar and Mediastinal Lymph Nodes are an Independent Prognostic Factor for Decreased Survival After Pulmonary Metastasectomy in Patients With Renal Cell Carcinoma

Surgical resection remains the most effective treatment in patients with pulmonary metastasis of renal cell carcinoma. To our knowledge the prognostic significance of mediastinal and hilar lymph node metastasis during pulmonary metastasectomy in patients with renal cell carcinoma is unknown. We analyzed the value of computerized tomography to predict mediastinal/hilar lymph node involvement as well as the impact of systematic lymphadenectomy on survival in patients with pulmonary renal cell carcinoma metastasis. We analyzed survival in 110 patients who underwent resection of pulmonary metastasis of renal cell carcinoma using the Kaplan-Meier method. Multivariate analysis was done by Cox regression analysis. Lymph node metastasis was histologically proved in 35% of patients. Metastasis was not associated with initial tumor grade, lymph node status, the number of pulmonary metastases or recurrent pulmonary metastasis. Computerized tomography had 84% sensitivity and 97% specificity to predict lymph node metastasis. Sensitivity was markedly better for detecting mediastinal than hilar lymph node metastasis (90% vs 69%). Patients with lymph node metastasis had significantly shorter median survival than patients without lymph node metastasis (19 vs 102 months, p <0.001). Multivariate analysis revealed that tumor infiltrated mediastinal lymph nodes were an independent prognostic factor for patient survival. Match paired analysis showed that after lymph node dissection patients showed a trend toward improved survival. Mediastinal and hilar lymph node metastases significantly correlate with decreased survival. Systematic lymphadenectomy provides valuable information on staging and prognosis in patients with pulmonary metastasis of renal cell carcinoma, and may prolong survival.

Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience

Despite the report of new treatment options, surgery remains the best treatment for pulmonary metastases from renal cell carcinoma (RCC). Repeat resection is also an effective means for recurrent pulmonary metastases. The aim of the present study was to define the prognostic factors for survival after pulmonary metastasectomy from RCC based on a 25-year single-centre experience. Between 1973 and 2008, 59 thoracotomies on 48 patients (38 men, 10 women) were performed in our hospital. Repeat resections were performed in eight patients. The clinicopathological and surgical data of these patients obtained from the medical records were analysed. The time interval between lung resection and death, or latest follow-up, ranged from 3 to 177 months (median 39 months). Survival analysis was conducted by the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox multivariate proportional hazard model. The cumulative 3-, 5- and 10-year survival rates were 60%, 47% and 18%, respectively. Multivariate analysis identified disease-free interval (DFI) (≥ 2 years) and complete resection as significant prognostic factors for survival. Among eight patients, who underwent repeat resection, two remain alive with no evidence of disease. These two patients had long DFI and long DFI-2 (time from first pulmonary metastasectomy to diagnosis of recurrent pulmonary metastasis). The results showed that (1) surgical resection of pulmonary metastasis from RCC has a favourable outcome in selected patients, (2) DFI and completeness of resection are prognostic markers for survival after pulmonary metastasectomy and (3) repeat lung resection for metastatic RCC is a safe procedure that provides satisfactory patient outcomes.

Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer

BackgroundIt remains controversial whether metastasectomy is still feasible in patients with pulmonary recurrence from colorectal cancer, after initial metastasectomy. The aim of this study was to evaluate outcomes of repeated metastasectomy in these patients. Materials and methodsFrom 1995 to 2007, 202 patients had received a pulmonary metastasectomy from colorectal cancer at our institution. Over a median follow-up of 28.9 months, 48 patients received second metastasectomy (29 wedge resections, 5 segmentectomies, 13 lobectomies, and 1 completion pneumonectomy). The median disease-free interval was 9.6 months. Among these 48 patients, 28 showed pulmonary recurrence again and of those, 10 patients received third metastasectomy (two wedge resections, two segmentectomies, four lobectomies, and two completion pneumonectomies). ResultsThere was no postoperative mortality. Of the 48 patients who underwent second metastasectomy, overall and disease-free 5-year survivals were 79% and 49%, respectively, after second operation. Of the 10 patients who received third metastasectomy, overall survival was 78% at 5 years after last operation. ConclusionsRepeated resection after initial metastasectomy can be carried out safely and provides long-term survival in patients with recurrent pulmonary metastasis from colorectal cancer. Our findings indicate that close follow-up for the early detection of recurrence and parenchyma-saving resection can improve the results after repeated resection.

Repeat resection of pulmonary metastasis is beneficial for patients with osteosarcoma of the extremities

Pulmonary metastasectomy in osteosarcoma can lead to long-term survival, but the role for repeat pulmonary metastasectomy is undefined. To confirm the value of repeat pulmonary resection of recurrent pulmonary metastases, we herein reviewed our institutional experience. Between 1989 and 2007, 25 patients with pulmonary metastases from osteosarcomas of the extremities underwent pulmonary resection, and 14 patients underwent repeat pulmonary metastasectomy. Ten of 14 patients underwent complete resection. Various perioperative variables were investigated retrospectively in these patients to confirm a role for repeat metastasectomy and analyze prognostic factors for overall survival (OS) after repeat pulmonary metastasectomy. OS rate after repeat pulmonary metastasectomy was 43% at two years and 19% at five years. On multivariate analysis, patients with complete resection presented significantly favorable OS (P=0.02). Interestingly enough, survival curve of patients with complete resection after the first pulmonary metastasectomy was almost the same as that of patients with complete resection after the second pulmonary metastasectomy. In conclusion, patients with complete resection for recurrent pulmonary metastasis show a significantly better prognosis after repeat pulmonary metastasectomy. Our data imply that repeat pulmonary metastasectomy might be beneficial because it can salvage a subset of patients with osteosarcoma who retain favorable prognostic determinants.

Resection of Pulmonary Metastasis of Non-small Cell Lung Cancer

Management of pulmonary metastasis of non-small cell lung cancer (NSCLC) remains controversial. We reviewed our surgical treatment for pulmonary metastasis of NSCLC. Seventy-six patients with pulmonary metastasis of NSCLC underwent pulmonary resections in two institutes during the past 10 years. Eighteen patients with simultaneous same lobe metastasis as the primary lesion underwent mostly lobectomies. Sixteen patients with simultaneous different lobe metastasis underwent combined margin-free resections. Forty-nine pulmonary metastasectomies were performed in 42 patients with recurrent lung cancer. Overall survival and disease-free survival in each group were examined, and factors affecting survivals were investigated. In the patients with the same lobe metastasis 5-year survival was 79.6%, and median and 5-year disease-free survivals were 39.1 months and 41.3%. In the patients with simultaneous different lobe metastasis median survival and 5-year survival were 37.7 months and 30.7%, and median and 5-year disease-free survivals were 13.3 months and 12.5%, respectively. Multiple pulmonary metastasis and mediastinal node metastasis were identified as significant factors affecting survivals. In the patients with recurrent pulmonary metastasis median survival and 5-year survival were 40.0 months and 34.8%, and median and 5-year disease-free survivals were 23.7 months and 14.4%, respectively. Node metastasis, higher age, and shorter interval from the prior resection were identified as significant factors affecting survivals. These findings suggest that the simultaneous same lobe metastasis is under the same indication for the primary lesion, and that the simultaneous different lobe metastasis and recurrent pulmonary metastasis should be removed in selected patients.