The role of surgery in lung metastases

doi:10.1053/ejso.1999.0667

European Journal of Surgical Oncology (EJSO)

Volume 25, Issue 4, August 1999, Pages 410-417

https://doi.org/10.1053/ejso.1999.0667 Get rights and content

Abstract

Aims:To evaluate the efficacy of pulmonary metastasectomy in 93 patients with lung metastases (LM) operated on from 1983 to 1997.Methods:We assessed: location and histological diagnosis of the primary tumour (PT); the extent of pulmonary resection; and disease-free interval (DFI). Survival analysis was undertaken using the Kaplan–Meier method.Results:Surgical complications occurred in eight (9%) patients; two (3%) died in hospital; seven (8%) were operated again because of further LM. In the whole patient group the average survival after metastasectomy was 40 months (median 22 months). The actuarial survival was 44% at 3 years and 35% at 5 years. With metastasectomy we achieved an overall survival after treatment of PT of 87 months (median 58 months). The actuarial survival was 58% at 5 years and 38% at 10 years. The average time between the treatment of PT and metastasectomy DFI was 4 years (median 41 months). Patients with a DFI of more than 2 years tended to live longer (P=0.086). There were 23 patients with non-epithelial and 70 patients with epithelial tumours. Their DFIs were similar (mean 47, median 34 months for non-epithelial and mean 51, median 29 months for epithelial tumours). Of patients with non-epithelial tumours, 38% survived for 5 years and their survival curves were similar. In the group of tumours with the most frequent location, the results of metastasectomy did not differ considerably: 5 year survival rates of 20% for patients with kidney tumours, 28% for colorectal cancer, 30% for soft-tissue sarcoma, 28% for skin melanoma and 18% for breast cancer.Conclusions:Lung metastasectomy seems to be a safe and efficient method of treatment even for patients who show further metastases. According to our study it seems that, except for LM of breast carcinoma (which has a slightly worse prognosis), the results of surgical resection are not dependent on either the location or the histological pattern of the PT. For this reason patients indicated for operation can be selected according to similar criteria.

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Cited by (20)

Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer
2013, Annals of Thoracic Surgery
Citation Excerpt :
Nevertheless, resection of isolated pulmonary metastases may be beneficial and increase OS in highly selected patients. This is supported by our results with 5- and 10-year survival rates of 59.6% and 43.0%, respectively, and by results reported by others [10, 12–15, 19–25]. Pulmonary metastasectomy was associated with low perioperative morbidity (7.6%) and lethality (0%), which has also been reported by others [14, 17, 23].
We investigated whether overall survival (OS) in patients with primary breast cancer (BC) is prolonged by pulmonary metastasectomy and which prognostic criteria may facilitate the decision in favor of thoracic surgical intervention.
We assessed the median OS of 81 women after resection of pulmonary primary BC metastases by means of Kaplan-Meier estimators. Statistical interferences regarding prognostic factors were based on univariate log-rank tests and multivariate Cox proportional hazards regression. Matched patients who had not undergone resection from the Munich Tumor Registry served as controls.
Between 1982 and 2007, 81 patients were recruited prospectively. In 81.5% of the patients R0 resection was achieved, which was associated with significantly longer median OS than occurred after R1 or R2 resection (103.4 months versus 23.6 months versus 20.2 months, respectively; p < 0.001). Multivariate analysis revealed R0 resection, number (n ≥ 2), size (≥ 3 cm), and estrogen receptor (ER) and/or progesterone receptor (PR) positivity of metastases as independent prognostic factors for long-term survival. Presence of metastases in mediastinal and hilar lymph nodes correlated with decreased survival only in the univariate analysis (32.1 versus 103.4 months; p = 0.095). Matched pair analysis confirmed that pulmonary metastasectomy significantly improved survival.
OS in patients with isolated pulmonary primary BC metastasis is prolonged by metastasectomy. Patients with multiple pulmonary lesions or metastases with negative hormone receptor (HR) status are at greater risk of disease relapse and should be followed closely. Moreover, additive treatment tailored to the biological subtype defined by HR expression should be considered for this group.
Prognostic factors of colorectal cancer lung metastases
2012, Cirugia Espanola
El carcinoma colorrectal es la tercera neoplasia más frecuente y la segunda causa de muerte por cáncer en los países desarrollados. Aproximadamente el 10% de los pacientes con este diagnóstico desarrollan metástasis pulmonares, Si bien solo el 2-4% de ellos tienen metástasis pulmonares como única localización de recidiva.
Estudio de los factores pronóstico de las metástasis pulmonares de carcinoma colorrectal.
Estudio observacional retrospectivo de 30 pacientes afectos de metástasis pulmonares de carcinoma colorrectal intervenidos quirúrgicamente en nuestro centro desde enero de 2003 hasta diciembre de 2007.
Se intervinieron un total de 30 pacientes, 19 varones (63%) y 11 mujeres (37%) con una edad media de 63,37 años (intervalo 35-82 años). La supervivencia global media fue de 36,64 meses (intervalo 18,58-54,70 meses).
Para el análisis estadístico se consideraron 13 parámetros, tanto preoperatorios como intra- y postoperatorios. En el análisis univariante, el número de metástasis superior a 3 (p = 0,051), la bilateralidad (p = 0,001) y la bilobularidad (p < 0,001) fueron factores de mal pronóstico estadísticamente significativos. En el análisis multivariante, solo la bilobularidad demostró ser un factor de mal pronóstico estadísticamente significativo (p = 0,005).
En nuestra serie de pacientes afectos de metástasis pulmonares de carcinoma colorrectal, el número de metástasis superior a tres, la bilobularidad y la bilateralidad resultaron factores de mal pronóstico.
Dichos factores deben tenerse en cuenta en el seguimiento de estos pacientes, aunque se necesitan estudios prospectivos con mayor número de casos para confirmar dichos hallazgos.
Colorectal cancer is the third most common neoplasia and the second cause of death due to cancer in developed countries. Approximately 10% of patients with this diagnosis develop lung metastases, although only 2-4% of them have lung metastases as the only extension location.
To study the prognostic factors of colorectal cancer lung metastases.
A retrospective observational study was conducted on 30 patients with colorectal cancer lung metastases who were operated on in our hospital between January 2003 and December 2007.
Of the 30 patients who received surgery, 19 were males (63%) and 11 were female (37%), with a mean age of 63.37 years (range 35-82 years). The mean overall survival was 36.64 months (range 18.58-54.70 months).
A total of 13 pre-, intra-, and postoperative parameters were used in the statistical analysis. In the univariate analysis, the number of metastases greater than 3 (P=.051), whether they were bilateral (P=.001), or bilobar (P<.001), were statistically significant factors of a poor prognosis. In the multivariate analysis, only being bilobar was shown to be a statistically significant factor of a poor prognosis (P=.005).
In our patient series affected by colorectal carcinoma lung metastases, the number of metastases greater than three, whether they are bilobar and bilateral, are factors of a poor prognosis.
These factors should be taken into account in the follow-up of these patients, although prospective studies with a larger number of patients are required to confirm these findings.
Surgical and nonresectional therapies for pulmonary metastasis
2010, Surgical Clinics of North America
Citation Excerpt :
The overall operative mortality in the International Registry of Lung Metastases study was 1.3% and the median survival of patients with complete resections of tumor was 35 months.2 The prognostic factors determined by this study have been supported by several other studies, which have also demonstrated 5-year survivals within the range listed by the Registry.8,9 One particular report by Girard and colleagues10 of 456 adult patients corroborated that the completeness of resection is prognostically significant to survival.
Surgical and Nonsurgical Therapy for Lung Metastasis: Indications and Outcomes
2007, Surgical Oncology Clinics of North America
Citation Excerpt :
Head and neck cancers and testicular and germ cell tumors tend to have better prognoses [78,83,90]. Tumor types with consistently lower survival rates after pulmonary metastasectomy are breast cancer and melanoma [90,91]. The benefit of repeated resections for recurrent pulmonary metastases remains controversial.
Surgical treatment of stage IV melanoma
2004, Clinics in Dermatology
Surgical therapy plays an important role in the management of selected patients with metastatic melanoma. Patients are frequently symptomatic from metastatic lesions, have few effective therapeutic options, and are faced with dismal outcomes. Surgical resection may provide successful palliation of symptomatic lesions with low morbidity and operative mortality. In carefully selected patients, resections performed with curative intent may result in improved survival if a pattern of disease recurrence suggestive of favorable tumor biology is present, and if complete resection of tumor is achieved. Because the majority of post-surgical metastatic patients eventually relapse and succumb to distant disease, adjuvant immunotherapeutic strategies are currently being evaluated.
Comment on "The process of metastasisation for breast cancer" by J. Engel, R. Eckel, J. Kerr et al. [1] (multiple letters)
2004, European Journal of Cancer

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European Journal of Surgical Oncology (EJSO)

Original ArticleThe role of surgery in lung metastases

Abstract

Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer

Prognostic factors of colorectal cancer lung metastases

Surgical and nonresectional therapies for pulmonary metastasis

Surgical and Nonsurgical Therapy for Lung Metastasis: Indications and Outcomes

Surgical treatment of stage IV melanoma

Comment on "The process of metastasisation for breast cancer" by J. Engel, R. Eckel, J. Kerr et al. [1] (multiple letters)

Original Article
The role of surgery in lung metastases