Results of surgical resection for lung metastases

Fifty-nine consecutive patients underwent thoracotomy with curative intent for lung metastases, with no operative deaths, between 1978 and 1996. Six patients could not be rendered free of disease; their long term survival was significantly lower respect to the 53 patients undergoing curative resection: 31% at one year versus 38% at five years respectively. By considering patients rendered free of disease, wedge excision was performed in 29 cases (55%) and it was the procedure of choice. Apart from resectability, the only significant factors influencing survival were morphology, with the best prognosis for carcinomas, intermediate for sarcomas and the worst one for melanoma and lymph node involvement, with a significant better survival for patients without nodal involvement. Survival was not influenced by primary site, disease-free interval, diameter and location of the pulmonary metastases, number of metastases resected and number of thoracotomies. We conclude that resection of lung metastases is safe and effective, that multiple lesions do not preclude resection but a known nodal involvement contraindicates it and that repeated thoracotomy is justified.