SURGERY FOR PULMONARY METASTASES - WHO ARE THE 10-YEAR SURVIVORS

Background. Surgical resection of pulmonary metastases (PMs) has been shown to produce approximately a 35% 5-year survival rate, but specifi c data about late survival are not available in the literature. Method s. A retrospective review and survival analysis of 186 adult patients who underwent surgery for PMs at a single center before Tune 1984 is p resented. Results. Of the 186 patients who had surgery, of whom 34 (18 %) had an incomplete resection, the 10-year survival rate (Kaplan-Meie r) was 23% (95% CI, 16-30%), and 36 patients, with PMs from nine diffe rent primary sites, were still at risk at 10 years. Two patients died of their primary disease more than 10 years after the first thoracotom y, and two are alive with uncontrolled disease. Thirty-one patients ar e currently alive and disease free. Comparison between the 36 10-year survivors and the 150 nonsurvivors revealed that only the percentage o f incomplete resections and the mean number of resections per patient were significantly different between the two groups (P < 0.001); the h istologic type of the primary tumor, the disease-free interval, and th e number of resected PMs at the first thoracotomy were not found to be statistically significant prognostic factors. Conclusions. The 23% 10 -year survival and the high rate of disease free 10-year survivors in this study constitute support for complete resection as an efficient t herapeutic approach in patients with isolated PMs. Relevant criteria t o select more precisely those patients who will benefit from resection remain to be developed.