The Effect of Lung Metastasectomy on Survival Rate of Patients, Massih Daneshvari Hospital Experience

Introduction & Although the presence of lung metastases of cancer indicates the an advanced and often incurable disease, nevertheless, there have been many efforts for the treatment of these patients by surgical resection of metastases. Results of these efforts have been variable in different reports and different histological types of tumors. In this study we report about our experience of lung metastatectomy and its survival benefits in our patients. In a retrospective study, we reviewed hospital files of 99 patients who had referred to us for the treatment of lung metastases during 1995-2007. Among them, 48 patients were selected for metastatectomy. The criteria for the selection were: complete resectability, absence of any extra-thoracic metastasis and suitable general condition of the patient for operation and controlled primary disease. The following data were extracted: site of primary lesion, histology, duration of the primary disease to the appearance of lung metastasis, surgical morbidity and mortality, type of surgical procedure, incision, number of metastases and survival of patients after metastatectomy. The patients were followed by out - patient visits and when necessary more information was collected through telephone calls. The data were analyzed by SPSS software and Kaplan-Mayer test was used to evaluate the survival results. Sixty seven surgical procedures were performed on 48 patients. There were 31 men and 17 women, with mean age of 40 years (16-86) years. Twenty Five patients had unilateral and 23 patients had bilateral lung metastases. In the case of bilateral metastases, single stage bilateral metastatectomy was done on 7 patients and in 16 patients metastatectomy was done in 2 or more stages. Types of incisions were: 60 posterolateral thoracotomy, 4 median sternotomy, and 3 clamshell bilateral thoracotomy with sternal transection. Sixty one metaetases removed by the wedge resection, 14 were removed by lobectomy and one removed by pneumonectomy. The mean number of removed lesions in each patient was 6.7 (1-59). There were 10(15%) surgical complications including: 9 pnemothorax and one chylothorax. There was no major or life threatening complication in any patient. The mean time of survival after metastatectomy was 22 month (1-128 month) and probability of 5 years survival was 24.5%. Five patients survived 5 years or more. Although the patients did not have the same histological types of cancers, it seems that metastatectomy has a definite beneficial effect on survival and sometimes results in the cure of cancer, morbidity and mortality of this procedure is also unremarkable.