Surgical resection of pulmonary metastases: Outcomes by histology
- Michael T Jaklitsch, MD
Michael T Jaklitsch, MD
- Professor in Surgery
- Harvard Medical School
- Brigham and Women's Hospital
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine
- National Jewish Health
Lung metastases from a primary extrapulmonary malignancy are often a manifestation of widespread dissemination; however, some patients have no other evidence of disease . Extensive experience with pulmonary metastasectomy in a number of different cancers has confirmed that resection is associated with prolonged relapse-free survival and cure in some patients . Based upon these observations, aggressive resection of isolated pulmonary metastases has become a widely accepted treatment for appropriately selected patients. However, a survival benefit from pulmonary metastasectomy has never been shown in a randomized trial for any histologic subtype, and questions remain as to whether it is the resection or simply selection of patients with a more favorable natural history that is responsible for the apparent improvement in survival associated with metastasectomy.
Data from the International Registry of Lung Metastases showed that the survival rates at 5, 10, and 15 years following complete resection in a variety of histologic tumor types were 36, 26, and 22 percent, respectively . The survival rate is influenced by the disease-free interval, number of metastases, and extent of resection. The potential benefits of resection and the approach to the patient are also dependent upon the histology of the tumor . (See "Surgical resection of pulmonary metastases: Benefits, indications, preoperative evaluation and techniques".)
This topic review will cover the outcomes of pulmonary metastasectomy in various tumor types and the use of adjuvant therapy following resection, where indicated. Specific issues related to patients undergoing resection of lung metastases from soft tissue sarcoma and a general discussion of the benefits of pulmonary metastasectomy, selection criteria, preoperative evaluation, and techniques for surgical resection are discussed elsewhere. (See "Surgical treatment and other localized therapy for metastatic soft tissue sarcoma" and "Surgical resection of pulmonary metastases: Benefits, indications, preoperative evaluation and techniques".)
The integration of surgery into multidisciplinary therapy for patients with specific malignancies is discussed in the appropriate topic reviews.
SOFT TISSUE SARCOMA
Soft tissue sarcomas primarily metastasize to the lungs, and surgery is the only potential curative treatment. The role of surgery in the treatment of lung metastases from soft tissue sarcoma is discussed elsewhere. (See "Surgical treatment and other localized therapy for metastatic soft tissue sarcoma", section on 'Pulmonary metastases'.)
- Farrell J. Pulmonary metastases: pathological, clinical roentgenological study based on 78 cases at necropsy. Radiology 1935; 24:444.
- Barney JD. Adenocarcinoma of the kidney with metastases to the lung cured by nephrectomy and lobectomy. J Urol 1939; 42:269.
- Pastorino U, Buyse M, Friedel G, et al. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997; 113:37.
- Saito Y, Omiya H, Kohno K, et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment. J Thorac Cardiovasc Surg 2002; 124:1007.
- Yedibela S, Klein P, Feuchter K, et al. Surgical management of pulmonary metastases from colorectal cancer in 153 patients. Ann Surg Oncol 2006; 13:1538.
- Kim S, Kim H, Hong Y, et al. The outcome of pulmonary metastasectomy from colorectal cancer and the role of postoperative chemotherapy (abstract). Data presented at the 2009 ASCO Gastrointestinal cancers Symposium, San Francisco, CA, January 16th, 2009.
- Rama N, Monteiro A, Bernardo JE, et al. Lung metastases from colorectal cancer: surgical resection and prognostic factors. Eur J Cardiothorac Surg 2009; 35:444.
- Lin BR, Chang TC, Lee YC, et al. Pulmonary resection for colorectal cancer metastases: duration between cancer onset and lung metastasis as an important prognostic factor. Ann Surg Oncol 2009; 16:1026.
- Kanzaki R, Higashiyama M, Oda K, et al. Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma. Am J Surg 2011; 202:419.
- Blackmon SH, Stephens EH, Correa AM, et al. Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer. Ann Thorac Surg 2012; 94:1802.
- Iida T, Nomori H, Shiba M, et al. Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg 2013; 257:1059.
- Tampellini M, Ottone A, Bellini E, et al. The role of lung metastasis resection in improving outcome of colorectal cancer patients: results from a large retrospective study. Oncologist 2012; 17:1430.
- Booth CM, Nanji S, Wei X, Mackillop WJ. Outcomes of Resected Colorectal Cancer Lung Metastases in Routine Clinical Practice: A Population-Based Study. Ann Surg Oncol 2016; 23:1057.
- Watanabe K, Nagai K, Kobayashi A, et al. Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer. Br J Surg 2009; 96:1058.
- Koga R, Yamamoto J, Saiura A, et al. Surgical resection of pulmonary metastases from colorectal cancer: Four favourable prognostic factors. Jpn J Clin Oncol 2006; 36:643.
- Iizasa T, Suzuki M, Yoshida S, et al. Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann Thorac Surg 2006; 82:254.
- Welter S, Jacobs J, Krbek T, et al. Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg 2007; 31:167.
- Onaitis MW, Petersen RP, Haney JC, et al. Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases. Ann Thorac Surg 2009; 87:1684.
- Zampino MG, Maisonneuve P, Ravenda PS, et al. Lung metastases from colorectal cancer: analysis of prognostic factors in a single institution study. Ann Thorac Surg 2014; 98:1238.
- Patel NA, Keenan RJ, Medich DS, et al. The presence of colorectal hepatic metastases does not preclude pulmonary metastasectomy. Am Surg 2003; 69:1047.
- Mise Y, Imamura H, Hashimoto T, et al. Cohort study of the survival benefit of resection for recurrent hepatic and/or pulmonary metastases after primary hepatectomy for colorectal metastases. Ann Surg 2010; 251:902.
- Gonzalez M, Robert JH, Halkic N, et al. Survival after lung metastasectomy in colorectal cancer patients with previously resected liver metastases. World J Surg 2012; 36:386.
- Mitry E, Fields AL, Bleiberg H, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol 2008; 26:4906.
- Brandi G, Derenzini E, Falcone A, et al. Adjuvant systemic chemotherapy after putative curative resection of colorectal liver and lung metastases. Clin Colorectal Cancer 2013; 12:188.
- Murthy SC, Kim K, Rice TW, et al. Can we predict long-term survival after pulmonary metastasectomy for renal cell carcinoma? Ann Thorac Surg 2005; 79:996.
- van der Poel HG, Roukema JA, Horenblas S, et al. Metastasectomy in renal cell carcinoma: A multicenter retrospective analysis. Eur Urol 1999; 35:197.
- Cerfolio RJ, Allen MS, Deschamps C, et al. Pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 1994; 57:339.
- Hofmann HS, Neef H, Krohe K, et al. Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. Eur Urol 2005; 48:77.
- Anraku M, Yokoi K, Nakagawa K, et al. Pulmonary metastases from uterine malignancies: results of surgical resection in 133 patients. J Thorac Cardiovasc Surg 2004; 127:1107.
- Harpole DH Jr, Johnson CM, Wolfe WG, et al. Analysis of 945 cases of pulmonary metastatic melanoma. J Thorac Cardiovasc Surg 1992; 103:743.
- Cho S, Ryu KM, Hwang YJ, Lee EB. Prognostic factors for pulmonary metastasectomy in the treatment of hepatocellular carcinoma. J Thorac Oncol 2010; 5:1251.
- Nakagawa T, Kamiyama T, Nakanishi K, et al. Pulmonary resection for metastases from hepatocellular carcinoma: factors influencing prognosis. J Thorac Cardiovasc Surg 2006; 131:1248.
- Kuo SW, Chang YL, Huang PM, et al. Prognostic factors for pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol 2007; 14:992.
- Chen F, Sato K, Fujinaga T, et al. Pulmonary resection for metastases from hepatocellular carcinoma. World J Surg 2008; 32:2213.
- Kwon JB, Park K, Kim YD, et al. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors. World J Gastroenterol 2008; 14:5717.
- Han KN, Kim YT, Yoon JH, et al. Role of surgical resection for pulmonary metastasis of hepatocellular carcinoma. Lung Cancer 2010; 70:295.
- Yoon YS, Kim HK, Kim J, et al. Long-term survival and prognostic factors after pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol 2010; 17:2795.
- Ohba T, Yano T, Yoshida T, et al. Results of a surgical resection of pulmonary metastasis from hepatocellular carcinoma: prognostic impact of the preoperative serum alpha-fetoprotein level. Surg Today 2012; 42:526.
- Kemp CD, Kitano M, Kerkar S, et al. Pulmonary resection for metastatic gastric cancer. J Thorac Oncol 2010; 5:1796.
- Yoshida Y, Imakiire T, Yoneda S, et al. Ten cases of resected solitary pulmonary metastases arising from gastric cancer. Asian Cardiovasc Thorac Ann 2014; 22:578.
- SOFT TISSUE SARCOMA
- COLORECTAL CANCER
- Significance of synchronous or metachronous liver metastases
- Benefit of postresection adjuvant therapy
- RENAL CELL CARCINOMA
- GERM CELL CANCER
- GYNECOLOGIC CANCERS
- HEAD AND NECK CANCER
- BREAST CANCER
- HEPATOCELLULAR CANCER
- GASTRIC CANCER
- SUMMARY AND RECOMMENDATIONS