Original article
General thoracic
Resection of Pulmonary and Extrapulmonary Sarcomatous Metastases Is Associated With Long-Term Survival

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
https://doi.org/10.1016/j.athoracsur.2009.04.144Get rights and content

Background

The presence of extrapulmonary sarcomatous metastases has traditionally been a contraindication for the resection of pulmonary metastases. We, therefore, reviewed our experience with resection of pulmonary metastases in patients who had documented extrapulmonary metastases to determine long-term outcome.

Methods

From 1998 to 2006, 234 patients underwent pulmonary metastasectomy. They were grouped as follows: group A (lung metastasectomy only); group B1 (with either synchronous or prior extrapulmonary metastasectomy); group B2 (with nonsurgical treatment of synchronous or prior extrapulmonary metastases); group C1 (with later extrapulmonary metastasectomy); group C2 (with later extrapulmonary metastasis which was not resected).

Results

Groups A, B1, and B2 consisted of 147 (62.8%), 26 (11.1%), and 13 (5.6%) patients, respectively. The median survival from lung metastasectomy date was 35.5, 37.8, and 13.5 months in groups A, B1, and B2, respectively. Comparison among the three groups showed no significant survival difference in groups A versus B1 (p = 0.96), but a survival difference was found comparing groups A versus B2 (p < 0.001) and B1 versus B2 (p < 0.001). Prognostic factors for increased survival included 3 or greater redo pulmonary operations, greater than 12 month mean time between pulmonary recurrences, greater than 24 month mean time between extrathoracic recurrences, and a prolonged disease-free interval. Prognostic factors for decreased survival included 3 or greater pulmonary metastases and group B2 patients.

Conclusions

These results suggest extrapulmonary metastases should no longer be viewed as a contraindication to resection of sarcomatous pulmonary metastases. Long-term survival can be achieved when a complete resection is possible for both the pulmonary and extrapulmonary metastases.

Section snippets

Patient Population

From 1998 to 2006, 15,744 patients with soft tissue and bone sarcoma were referred to The University of Texas M.D. Anderson Cancer Center. During this interval, 4,355 (27.7%) patients were diagnosed with sarcomatous pulmonary metastases. They received various combinations of treatment ranging from chemotherapy, radiotherapy, and surgery. Patients were referred for immediate surgery if they presented with a single pulmonary metastasis or a limited number of metastases and a long disease-free

Patient Characteristics and Histology

Out of 4,355 patients with sarcomatous pulmonary metastases, 234 (5.6%) patients were treated with pulmonary metastasectomy. The mean and median ages at diagnosis of primary sarcoma were 42.5 and 43 years, respectively, and the age range was 8 to 83 years. Of these, 123 (52.6%) were men and 111 (47.4%) were women. The frequency distribution and definition of the different resection groups is shown in Table 1. The frequency distribution of patient characteristics and primary histology according

Comment

Sarcomatous pulmonary metastasectomy remains the cornerstone for treatment of isolated pulmonary metastases. Resection of extrathoracic pulmonary metastases in conjunction with lung metastases has to this point not been evaluated. This single-institution review provides new prognostic indicators as well as an evaluation of a previously unvalidated treatment paradigm. Long-term survival can be achieved when a complete resection is possible for both pulmonary and extrapulmonary metastases.

The

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