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 Emeritus
- 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 the 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 International Registry of Lung Metastases found similar survival rates in patients with epithelial carcinomas and in those with sarcomas . Among 1917 patients with sarcoma pulmonary metastases, overall survival was 31 percent at five years and 26 percent at 10 years, with a median survival of 29 months . These outcomes have been further corroborated by a 2017 analysis of the Memorial Sloan Kettering Cancer Center (MSKCC) database . Over 25 years, 539 patients underwent 760 metastasectomies of soft tissue sarcoma with curative intent. Although there was a short median disease-free survival of 6.8 months, the median overall survival was 33.2 months. Perhaps more importantly, there was a long survival tail to the Kaplan-Meier curve, with 47 percent surviving three years, 34 percent surviving five years, and 23 percent surviving seven years. In another series, the overall survival of patients with leiomyosarcoma pulmonary metastases was particularly favorable, with a median survival of 70 months .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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