Extended pulmonary metastasectomy : is it worthwhile?

OBJECTIVE: the role of extended pulmonary resection for lung metastases is still unclear, and very poor information is available in literature. This study was performed to analyze the outcomes and prognostic factors of extended resections for pulmonary metastases. METHODS: from 1998 to 2013, 1027 patients underwent lung metastasectomy procedures. Twenty nine patients had extended pulmonary resections: 3 resection of the chest wall, 1 azygos, 1 diaphragm, 4 vascular resections/reconstructions, 6 sleeve resections, and 14 pneumonectomies. RESULTS: extended resection was performed for metastatic disease mainly from epithelial (62.1%) and sarcomatous (20.7%) tumors. Complete resection was obtained in all patients. 30-day operative morbidity and mortality rate was respectively 38% (11/29) and 0%. Only one patient had a major complication due to bronco pleural fistula. The mean duration of hospital stay was 6 days. After a mean follow-up of 51 months, 16 patients (55%) had died. Survival was determined by histology of the primary tumor (p=0.01), and not by number of metastases, nodal status, DFI and extension of surgery (pneumonectomy vs. lobar resection). The actuarial survival after complete extended metastasectomy was 66% at 2 years, 42% at 5 years, and 36% at 10 years. CONCLUSIONS: Extended resections, which can be performed during pulmonary metastasectomies, were associated with low rates of mortality and morbidity, and an acceptable long-term survival when performed in selected patients amenable to complete resection.21