AGGRESSIVE PULMONARY METASTASECTOMY FOR SOFT-TISSUE SARCOMAS

Background. To evaluate the efficacy of aggressive pulmonary metastase ctomy for treating soft tissue sarcomas, the clinical data on the surg ical management of 23 patients with extensive pulmonary metastases fro m soft tissue sarcomas were reviewed. Methods. Between January 1973 an d April 1991, 9 male patients and 14 female patients were treated. The ir ages ranged from 13-68 years (median, 42 years). Twenty-one patient s (91%) had bilateral and multiple metastases, and two patients had so litary metastasis. The number of resected metastatic nodules ranged fr om 1-110 (mean, 30.5). As an initial surgical approach, median sternot omy was used on 18 patients and lateral thoracotomy on 5 patients. Ele ven patients underwent two or more explorations for recurrent metastas es using lateral thoracotomy. The neodymium:yttrium-aluminum-garnet (N d:YAG) laser was adopted in 10 patients since 1986. Results. The actua rial 2-year and 5-year survival rates after the first pulmonary resect ion were 49.7% and 24.8%, respectively. Histologic type (alveolar soft part sarcoma versus synovial sarcoma, P < 0.025), histologic grade (G 1 and G2 versus G3, P < 0.01), and metastatic localization (subpleural versus extrapleural, P < 0.005) were the most significant prognostic factors for aggressive pulmonary metastasectomy of soft tissue sarcoma s. Application of laser surgery, absence of local recurrences, and abs ence of extrapulmonary metastases before pulmonary resection also corr elated with better prognosis with borderline significance. Conclusions . Aggressive pulmonary metastasectomy for soft tissue sarcomas is a re commended procedure, even in the case of extensive metastases. The com bination of median sternotomy and Nd:YAG laser-assisted surgery is a u seful technique, especially in bilateral multiple pulmonary metastases .