Surgical treatment of lung metastases: Prognostic factors for long-term survival

Background and Objectives: Surgical resection of lung metastases is an esta blished therapy for a large number of primary tumors, but there is some con troversy about prognostic factors for long-term survival. Methods: From 1968 to 1996, we performed a retrospective review of a series of 85 patients (100 operations) that have been operated for resection of l ung metastases. The Kaplan-Meier method was used to estimate the probabilit ies of survival, the log-rank test for the univariate analysis of prognosti c factors for survival, and the Cox model in the subsequent multivariate an alysis. Results: The operative mortality was 4% and the morbidity 18%. The mean fol low-up after lung resection was 22.13 months (1-146). The actuarial 5-year survival rate was 29.2%. By univariate analysis, the following factors were associated with survival after resection: location and histology of the pr imary tumor, greatest dimension of the largest metastasis, radicality of th e resection, involvement of the resection margins, and use of adjuvant ther apy (P < 0.05). After multivariate analysis, only the dimension of the meta stases and involvement of surgical margins have been found to be independen tly associated with survival. Conclusions: Surgical excision is a safe and effective therapy for lung met astases from a large number of primary tumors, provided a complete resectio n is feasible. (C) 1999 Wiley-Liss, Inc.