Lung metastasectomy in adenoid cystic carcinoma (ACC) of salivary gland

To define the role of surgical management of lung metastases in ACC. Twenty ACC patients referred to lung metastasectomy were retrospectively reviewed. Twenty-six operations were performed; at the first metastasectomy, a resection with clear margins (R0) was achieved in 11 patients (55%), 3 are alive and well. Four out of 9 patients with residual disease (R2) are still alive. Median survival after metastasectomy was 78 and 52 months for R0 and R2 (p = 0.4); median freedom from progression (FFP) in R0 and R2 groups was 30 and 15 months (p = 0.2), respectively. A better outcome was obtained for patients with a disease-free interval ≥36 months and ≥6 metastases and bilateral involvement were critical in achieving a R0 intervention. Lung metastasectomy provided a prolonged FFP in a high selected subset of patients with ACC. However, if this could be translated into a survival benefit, it is still to be demonstrated.