Who Actually Profits from Pulmonary Metastasectomy Operation? Retrospective Analysis of 12 Years

Objective: Evaluating the benefits of metastasectomy and the possible prognostic factors associated with overall survival after surgical treatment.
Methods: Between January 2000 and January 2012, 148 pulmonary metastasectomy operations were performed on 126 patients (78 males, 48 females), with a median age of 32. Data were examined retrospectively for age, gender, primary tumor histology, number of lesions, operative techniques, resection margins, mediastinal lymph node involvement, time to metastasis, and additional therapies. Effects of possible prognostic factors on 2-year and 5-year survival were then evaluated.
Results: Most patients (84%) were asymptomatic; 126 patients underwent 148 metastasectomy operations. Definitive pathology revealed sarcoma in 63 (50%), epithelial tumor in 58 (46%), and melanoma in 5 (4%). Complete resection (R0) was achieved in all patients. Average postoperative hospital length of stay was 5.4 (range: 2-8) days. Morbidity was 6.3%, and 30-day mortality was 1.6%. Median overall survivals were found to be 42, 27, and 11 months (p=0.029), with median disease-free intervals of 32, 21, and 7 months for epithelial tumors, sarcomas, and melanomas, respectively (p<0.001). The median survival of patients with single, 2 to 3, and 4+ metastatic nodules was 30, 18, and 15 months, respectively (p=0.012). Median survival of patients with a disease-free interval of less than 12 months was 16 versus 30 months in those with an interval of more than 12 months (p=0.003). Additional mediastinal lymph node involvement was directly correlated with a worse outcome (p=0.044).
Conclusion: Pulmonary metastasectomy is a safe and effective choice of treatment. Univariate analyses verified that histopathology of the tumor, disease-free interval, number of metastatic lesions, and lymph node involvement were significant prognostic factors in patients undergoing pulmonary metastasectomy.
Objective: Evaluating the benefits of metastasectomy and the possible prognostic factors associated with overall survival after surgical treatment.
Methods: Between January 2000 and January 2012, 148 pulmonary metastasectomy operations were performed on 126 patients(78 male, 48 female), with median age of 32. Data were examined retrospectively for age, gender, primary tumor histology, number of lesions, operative techniques, resection margins, mediastinal lymph node involvement, time-to-metastasis, and additional therapies. Effects of possible prognostic factors on 2-year and 5-year survivals are then evaluated.
Results: Most patients (84%) were asymptomatic. 126 patients underwent 148 metastasectomy operations. Definitive pathology revealed sarcoma in 63 (50%), epithelial tumor in 58 (46%) and melanoma in 5 (4%). Complete resection (R0) was achieved in all. Average postoperative hospital length-of-stay was 5.4 (range: 2-8) days. Morbidity was 6.3% and 30-day mortality was 1.6%. Median overall survivals were found to be 42, 27 and 11 months (P=0.029); with median disease-free intervals of 32, 21, and 7 months for epithelial tumors, sarcomas, and melanomas, respectively (P<0.001). Median survivals of patients with single, 2 to 3, and 4+ metastatic nodules were 30, 18 and 15 months, respectively (P=0.012). Median survivals of patients with disease-free interval of less than 12 months were 16 vs. 30 months of those with an interval more than 12 months (P=0.003). Additional mediastinal lymph node involvement was directly correlated with worse outcome (P=0.044).
Conclusion: Pulmonary metastasectomy is a safe and effective choice of treatment. Univariate analyses verified the histopathology of tumor, disease-free interval, number of metastatic lesions, and lymph node involvement were significant prognostic factors in patients undergoing pulmonary metastasectomy.