Mt. Jaklitsch et al., Sequential thoracic metastasectomy prolongs survival by re-establishing local control within the chest, J THOR SURG, 121(4), 2001, pp. 657-667
Citations number
20
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: The value of sequential thoracic metastasectomies is unknown. We
evaluate repeat metastasectomy for limited recurrences within the thorax.
Methods: From July 1988 to September 1998, 54 patients underwent 2 to 6 sep
arate sequential procedures to excise metastases after recurrence isolated
to the thorax. Kaplan-Meier survival and Cox modeling determined prognostic
variables.
Results: Thirty-three men and 21 women, 22 to 76 years underwent 2 (100%, n
= 54), 3 (50%), 4 (22%), or 5 to 6 (11%) metastasectomies. Fifty-four perc
ent of patients had carcinoma, 35% sarcoma, 9% germ cell, and 2% melanoma.
There were no operative deaths; all late deaths occurred from cancer. Media
n follow-up was 48 months. Cumulative 5-year survival from the second proce
dure was 57%. After the second, third, fourth, and fifth procedures, respec
tively, permanent control was achieved in 15 (27%) of 54 patients, 5 (19%)
of 27, 1 (8%) of 12, and 0 of 7. Recurrence amenable to additional surgery
occurred in 27 (50%) of 54, 12 (44%) of 27, 6 (50%) of 12, and 1 (17%) of 6
. Mean hazard fur the development of unresectable recurrence increased from
0.21 after the second procedure to 0.91 after the fifth procedure, The 5-y
ear survival for the 27 patients undergoing only 3 metastasectomies was 60%
(median not yet reached), 33% for the 15 patients undergoing only 3 metast
asectomies (median 34.7 months), and 38% for the 12 patients undergoing 4 o
r more (median 45.6 months). From the time a recurrence was declared unrese
ctable, patients had a 19% 2-year survival (median 8 months).
Conclusions: Multiple attempts to re-establish intrathoracic control of met
astatic disease is justified in carefully selected patients, but the magnit
ude of benefit decays with each subsequent attempt.