Prolonged survival after extracranial metastasectomy from synchronous resectable lung cancer

Background: Combined resection of solitary synchronous brain metastases and non-small-cell lung cancer has been shown to be successful. Thus, we propo sed combining the surgery of solitary, extracranial metastases, and resecta ble lung cancer. Methods: Between March 1987 and December 1994, surgery was performed on nin e patients with non-small-cell lung cancer with synchronous, solitary, extr acranial, or distant metastasis: adrenal (n = 5), cutaneous (n = 2), axilla ry lymph node (n = 1) and kidney (n = 1). Criteria for operating on these p atients included: primary tumor that was locally resectable in a radical ma nner, non-small-cell histology, no preoperative evidence of N2 disease, com plete resection of histologically proven metastasis, and absence of other m etastases found with computed tomography or bone scan. Results: Resection of the primary tumor and solitary metastases was achieve d in all patients. Primary tumor was always resected by lobectomy. No morta lity or major morbidity was reported. Five-year survival rate was 55.6%. Fi ve patients who had adrenal (n = 3), or skin (n = 1), or axillary (n = 1) m etastases, survived more than 5 years. All N2 patients (n = 2) died. Conclusions: The presence of solitary, distant metastasis should not be con sidered, per se, a factor for denying surgery for locally resectable, non-s mall-cell lung cancer. Unexpected, prolonged survival was demonstrated in o ur limited series.