SURGICAL RESECTION OF PULMONARY METASTASES - UP TO WHAT NUMBER

Specific results on the surgical resection of a large number of pulmon ary metastases (PM) are currently unavailable, and the risk-benefit ra tio of this aggressive approach may appear questionable. A systematic review of the records of 456 adult patients who underwent thoracic sur gery for PM between 1979 and 1990 led to the identification of 44 pati ents who underwent at least one resection of eight or more PM (range e ight to 110), of whom 33 (75%) had PM from osteogenic or soft tissue s arcoma. These 44 patients underwent a total of 77 operations, of which 47 (61%) were bilateral and nine (12%) incomplete resections. The 3- and 5-yr probabilities of survival after the first resection of eight or more PM were 36 and 28%, respectively, and were not significantly d ifferent from those of the 412 other patients who underwent surgery fo r PM over the same period. In this small group of patients, only the q uality of resection (complete or incomplete) was found to be a highly significant prognostic factor (p < 0.01). A critical analysis of the r eported data supports the view that, at least in patients with osteoge nic or soft tissue sarcoma, the prognostic value of the number of PM s eems to be more dependent on associated resectability than on the numb er per se and that, after careful preoperative patient selection, PM t hat can be resected should be resected, whatever their number.