LONG-TERM RESULTS AFTER REPEATED SURGICAL REMOVAL OF PULMONARY METASTASES

Background. Although surgical resection is accepted widely as first-li ne therapy for pulmonary metastases, few data exist on the surgical tr eatment of recurrent pulmonary metastatic disease. In a retrospective study, we analyzed patients who were operated on repeatedly for recurr ent metastatic disease of the lung with curative intent over a 20-year period. Methods. From 1973 to 1993, 396 metastasectomies were perform ed in 330 patients. The study population included patients with any hi stologic tumor type who had undergone at least two (range, 2 to 4) com plete surgical procedures because of recurrent metastatic disease. Sur gical and functional resectability of the recurrent lung metastases an d control of the primary lesion served as objective criteria for reope ration. A subgroup of 35 patients that included patients with histolog ic findings such as epithelial cancer and osteosarcoma then was analyz ed retrospectively to calculate prognosis and define selection criteri a for repeated pulmonary metastasectomy. Results. The 5- and 10-year s urvival rates after the first metastasectomy were 48% and 28%, respect ively. The overall median survival was 60 months. A mean disease-free interval (calculated for all intervals, with a minimum of two) of grea ter than 1 year was significantly associated with a survival advantage beyond the last operation. Univariate analysis failed to show size, n umber, increase or decrease in number or size, or distribution of meta stases as factors related significantly to survival. Conclusions. Alth ough patients with different histologic tumor types were included, the study population appeared to be homogenous in terms of survival benef it and prognostic factors, and it probably represented the selection o f biologically favorable tumors in which histology, size, number, and laterality are of minor importance. We conclude that patients who are persistently free of disease at the primary location but who have recu rrent, resectable metastatic disease of the lung are likely to benefit from operation a second, third, or even fourth time. (C) 1998 by The Society of Thoracic Surgeons.