PULMONARY METASTASES OF ENDOCRINE ORIGIN - THE ROLE OF SURGERY

Purpose: To determine the clinical course and outcome of patients unde rgoing pulmonary resection for metastatic endocrine tumors. Methods: R etrospective review of 47 patients with known endocrine tumors and pul monary metastases who were evaluated for surgical resection between 19 75 and 1996, Results: Tumors evaluated included the following: carcino id (16), thyroid (12), pancreatic adenocarcinoma (10), adrenocortical carcinoma (6), pheochromocytoma (2), and parathyroid (1). Thirty-three patients were asymptomatic. Hormone secretion was noted in five patie nts, Twenty-five patients, who had isolated lung metastases, good cont rol of the primary tumor, and no medical contraindication had surgical resection. The number of pulmonary nodules was not se limiting factor as long as all disease could be resected with adequate residual pulmo nary function. CT was successful in directing resection in all patient s, Twenty-six operations were performed in 25 patients and 22 patients were treated medically. Wedge resection was performed for lesions <2 can (15), and lobectomy for larger or multiple nodules (10). Four pati ents had bilateral nodules resected. There was no operative mortality and no major complications. Actuarial 5-year survival was 61% for surg ically treated patients. Independent predictors of poor survival inclu ded positive mediastinal lymph nodes at time of surgery (p=0.004) and shorter disease-free interval (p=0.01). At a median of 6.7+/-1.2 years , six patients have developed radiographic appearance of a recurrence. A single patient with recurrent Hurthle cell cancer has had a success ful reresection. The remaining patients have received chemotherapy. No patient with pancreatic carcinoma or adrenocortical carcinoma was a c andidate for resection. All medically treated patients died within 6 m onths. Conclusion: Patients with endocrine tumors and pulmonary metast ases are usually asymptomatic, their conditions are diagnosed accurate ly with CT, and they can achieve long-term survival comparable to othe r tumors (sarcoma) after pulmonary metastasectomy. Clinical implicatio ns: Patients with carcinoid, thyroid, pheochromocytoma, and parathyroi d tumors with pulmonary metastases should undergo surgical resection i f there is the following: (1) no evidence of extrathoracic disease; (2 ) good control of the primary tumor; (3) no medical contraindications for surgery; and (4) pulmonary function that can tolerate resection of all documented disease. The role of adjuvant chemotherapy in patients with positive lymph nodes needs further study.