Resection of lung metastases: Long-term results and prognostic analysis based on 5206 cases - The International Registry of Lung Metastases

The International Registry of Lung Metastases was established in 1991 to as ses the long-term results of pulmonary metastasectomy. The Registry has acc rued 5206 cases of lung metastasectomy, from 18 departments of thoracic sur gery in Europe (n = 13), USA (n = 4) and Canada (n = 1). Of these patients 4572 (88%) underwent complete surgical resection. The primary tumor was epi thelial in 2260 (43%), sarcoma in 2173 (42%), germ cell in 363 (7%), and me lanoma in 328 (6%) patients. The disease-free interval was 0 to 11 months i n 1729 (33%) cases, 12 to 35 months in 1857 (36%) and more than 36 months i n 1620 (31%). Single metastases accounted for 2383 (46%) cases and multiple lesions for 2726 (52%). Mean follow up was 46 months. Analysis was perform ed by Kaplan-Meier estimates of survival, relative risk of death and multiv ariate Cox model. The actuarial survival after complete metastasectomy was 36% at 5 years, 26% at 10 years and 22% at 15 years (median 35 months); the corresponding values for incomplete resection were 13% at 5 years and 7% a t 10 years (median 15 months). Among complete resections, the 5-year surviv al was 33% for patients with a disease free-interval of 0 to 11 months and 45% for those with a disease-free interval of more than 36 months; 43% for single lesions and 27 for four or more lesions. Multivariate analysis showe d a better prognosis for patients with germ cell tumors, disease-free inter val of 36 months and more and single metastases. These results confirm that lung metastasectomy is a safe and potentially curative procedure.