Results of thoracotomy in osteogenic sarcoma with pulmonary metastases.

BACKGROUND Resection of pulmonary metastases may be followed by long term survival and now that it is an accepted method of treatment for patients with osteogenic sarcoma indicators of favourable prognosis are needed to aid the assessment of suitability for resection. This study compares the survival rates of patients who did and did not undergo resection of their pulmonary metastases and relates them to prognostic indicators. METHODS The study population was the 43 patients with osteosarcoma who developed pulmonary metastases out of the 111 patients with osteosarcoma treated by the Birmingham bone tumour treatment service during 1977-83. All patients who developed metastases confined to the lungs were considered for resection, thoracotomy being advised for all patients (provided that they were fit enough) who had metastases thought to be resectable even if they were multiple. RESULTS Of the 18 patients who did not have a thoracotomy, 15 died of disseminated disease after a mean interval of eight months; one patient died of cardiomyopathy and two are alive after 26 and eight months. Of the 25 patients who underwent thoracotomy in an attempt to resect metastases, three were found to have inoperable disease and died after a mean interval of 5.4 months from thoracotomy. Overall, after thoracotomy (repeated if necessary) there was a 20% survival at five years from the first thoracotomy. When survival was assessed with respect to the disease free interval and the number and bilaterality of the metastases no significant relationships were found. There was, however, a significant relation between survival and the position of metastases, patients with metastases confined to one lobe of the lung having a mean survival of 29.5 months, compared with 13.7 months in patients with disease in more than one lobe. CONCLUSION Thus patients who had a thoracotomy survived longer from the time of diagnosis of pulmonary metastasis than those not undergoing thoracotomy; metastases confined to one lobe predicted a better prognosis.     

Improved survival after resection of pulmonary metastases from malignant melanoma

The value of resecting pulmonary metastases from malignant melanoma was retrospectively examined. Between 1981 and 1989, 56 patients (35 men and 21 women with a mean age of 49 years) had 65 pulmonary resections for histologically proven metastatic melanoma after treatment of the primary tumor. In patients undergoing thoracotomy, 50% (28/56) had pulmonary metastases as the initial site of recurrence. Twenty-eight patients (50%) had local-regional recurrence before the development of lung metastases. Eight lobectomies, two segmentectomies, and 55 wedge excisions were done. Fifty-four patients (54/56, 96%) underwent complete resection, and there were no operative deaths. The postthoracotomy actuarial survival was 25% at 5 years (median interval, 18 months). Location of the primary tumor, histology, thickness, Clark level, local-regional lymph node metastases, or type of resection was not associated with improved survival. Patients without regional nodal metastases before thoracotomy had a median survival of 30 months compared with 16 months for all others (p = 0.04). Patients with lung as the site of first recurrence had a median survival of 30 months compared with 17 months for patients with initial local-regional recurrence (p = 0.038, log-rank test). Despite systemic spread, patients with isolated pulmonary metastases from melanoma may benefit from metastasectomy.     

Cancer Resection on the Residual Lung After Pneumonectomy for Bronchogenic Carcinoma

Background. After pneumonectomy for bronchogenic carcinoma, the residual lung may be the site of a new lung cancer or metastatic spread.

Methods. From 1989 to 1995, 13 patients with carcinoma on the residual lung after pneumonectomy for lung cancer were operated on. Three segmentectomies and 7 simple wedge resections were performed, 2 patients had multiple wedge resections, and 1 patient had an exploratory thoracotomy. Nine patients had a primary metachronous bronchogenic carcinoma, 3 had metastases from bronchogenic carcinoma, and no definite conclusion was reached in 1 case.

Results. No postoperative mortality was observed. Four patients had postoperative complications. The mean postoperative hospital stay was 14 days. Seven patients are alive, including 5 patients without evidence of disease. Six patients died of their disease, all with pulmonary recurrences. The overall median survival was 19 months, with a probability of survival at 3 years (Kaplan-Meier) of 46% (95% confidence interval, 22% to 73%).

Conclusions. Limited pulmonary resection for lung cancer after pneumonectomy for bronchogenic carcinoma is feasible with very low morbidity. In highly selected patients, surgical resection might prolong survival.     

Pulmonary metastases in children: results of surgical treatment

A retrospective analysis, from 1965 to 1987, of 22 patients less than 18 years of age undergoing thoracotomy for pulmonary metastases from previously diagnosed malignancy, was performed. There were 15 males and seven females whose ages ranged from 8 months to 17, years. Ten patients had primary osteogenic sarcoma, five had Wilms' tumor, and seven had miscellaneous other tumors. A total of 41 thoracotomies were performed with no mortality. The overall survival rate was 54.5%, with an average survival of 6.2 years after initial diagnosis. The osteosarcoma group had a 50% survival rate after an average of 62 months from initial diagnosis, while the Wilms' tumor group had an 80% survival rate with a 100-month average. The remaining seven patients had a 29% average survival rate 62 months after diagnosis. Of the 12 patients undergoing wedge resections, two died upon follow-up 20 and 21 months after initial diagnosis. As opposed to the survivors in this group, both required more than four wedge resections upon initial thoracotomy. Two patients requiring extended resections, one for Ewing's sarcoma and one for hepatoblastoma, died 35 and 3 months after diagnosis, respectively. Of the eight patients undergoing lobectomy and/or segmentectomy, 75% died an average of 31.3 months after diagnosis. Ten patients had two or more thoracotomies for an average of 2.9, with a 40% survival rate. Of the 27% who presented with initial bilateral lung metastases, 33% survived. Forty-five percent of patients had a tumor-free interval of less than 12 months prior to thoracotomy, resulting in a 60% mortality rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term survival after resection of pulmonary metastases from carcinoma of the breast.

Resection of isolated pulmonary metastases may yield improved survival in select patients. Between 1981 and 1991, 44 women (median age, 55 years) with a history of breast cancer underwent 47 thoracotomies with no operative deaths and only three minor postoperative complications (3/47, 6.4%). Confirmation of the metastatic origin of the lung lesion was made by direct histological comparison with the primary. Three patients had benign nodules and were excluded, and 4 patients had less than complete resection at thoracotomy. The median survival after thoracotomy of the remaining 37 patients with completely resected metastases was 47 +/- 5.5 months, and their actuarial 5-year survival was 49.5%. Patients with a disease-free interval of longer than 12 months had a longer survival (median survival, 82 +/- 6 months; 5-year survival, 57%) than patients with a disease-free interval of 12 months or less (median survival, 15 +/- 3.6 months; 5-year survival, 0%) (p = 0.004). Patients with estrogen receptor-positive status (n = 14) tended to have longer survival after resection than patients with estrogen receptor-negative status (n = 15) (median survival, 81 +/- 9 months versus 23 +/- 6 months, respectively; p = 0.098). Other clinical variables analyzed did not predict survival after thoracotomy. We conclude that resection of pulmonary metastases in patients with breast cancer can be done safely and may result in long-term survival for a substantial number of patients. Patients with a disease-free interval of longer than 12 months have an excellent prognosis after complete resection.     

Aggressive Pulmonary Resection for Metastatic Osteogenic and Soft Tissue Sarcomas

From July, 1974, to July, 1979, 36 patients with osteogenic sarcoma and 25 patients with soft tissue sarcoma underwent a total of 95 thoracotomies for resection of isolated pulmonary metastases. In only 6 patients could all palpable disease not be resected, although it was certain that microscopic disease remained in some patients. Twenty-six patients underwent more than 1 thoracotomy. The pulmonary lesions were found not to be metastases in 4 patients with osteogenic sarcoma and 4 with soft tissue sarcoma. The four-year survival for patients with nonsynchronous metastases from osteogenic sarcoma was 44%, not significantly different from a survival of 35% for patients with soft tissue sarcomas. The 6 patients with synchronous osteogenic sarcoma metastases all died within 16 months.Survival following thoracotomy did not correlate statistically with time from primary tumor resection to lung recurrence, unilateral versus bilateral disease, or number of nodules. For the 33 patients in whom tumor doubling time could be calculated, survival with either type of sarcoma was significantly better in patients with a tumor doubling time greater than 40 days versus a tumor doubling time less than or equal to 40 days. Any patient with metastatic osteogenic sarcoma or soft tissue sarcoma confined to the lungs should be considered for resection in conjunction with chemotherapy.     

Survival, disease-free interval, and associated tumor features in patients with colon/rectal carcinomas and their resected intra-pulmonary metastases

Objective: Colon/rectum cancer often presents with intrapulmonary metastases. Surgical resection can be performed in a selected group of patients. In this study, the search for possible prognostic factors of patients with primary colon/rectum cancer and lung metastases was performed. Methods: Medical records of 110 patients operated on pulmonary metastases of primary colon/rectum cancer were reviewed. The clinical parameters include age, sex, pTNM/UICC stage, grading, localization, surgical and adjuvant therapy of the primary cancer. The number, maximum diameter and total intra-thoracic resected tumor-mass (‘load’), the pre-thoracotomy serum carcinoembryonic antigen (CEA) levels, localization of the metastases (uni- vs. bilateral), the presence of hilar/mediastinal tumor-infiltrated lymph nodes, the surgical procedure and performed therapy schemes of lung metastases were recorded. Results: The cumulated 5- and 10-year total survival after diagnosis of the primary carcinomas was estimated to 71 and 33.7%, respectively. After resection of the pulmonary metastases, the 3- and 5-year post-thoracotomy survival measured 57 and 32.6%, respectively. The median time interval between diagnosis of the primary cancer and thoracotomy (disease free interval (DFI)) was found to be 35 months. A non-negligible percentage of patients (15.4%) displayed limited tumor stages of the primary cancer (pT1/2, pN0). The median diameter of the largest metastasis measured 28 mm, and the median resected intrathoracic tumor-load was calculated to 11.4 cm³. In only 8 patients hilar or mediastinal tumor-involved lymph nodes were found. A potentially curative resection of lung metastases was recorded in 96 patients. The overall survival was significantly correlated with the DFI and the number of intrapulmonary metastases. The DFI correlated significantly with the tumor load and the number of metastases; the post-thoracotomy survival with the number of metastases, tumor-load and pre-thoracotomy serum CEA level. Treatment, stage and grade of the primary cancer, occurrence of liver metastases and local recurrences, mode of treatment of metastases and postoperative residual stage had no significant correlation with either total nor post-thoracotomy survival. Conclusions: Pulmonary metastases occur even in patients with limited tumor-stages of primary colon/rectum cancer. DFI is the major parameter to estimate the total survival of patients with lung metastases. The survival after thoracotomy depends on the number of metastases, the intrapulmonary tumor load and the presence of elevated serum CEA level prior to thoracotomy.     

Results of surgical resection of pulmonary metastases of squamous cell carcinoma of the head and neck.

In this retrospective review of 58 patients (12 females and 46 males) with pulmonary metastases of squamous cell carcinoma of the head and neck treated between January 1, 1970, and December 31, 1989, we evaluated their clinical courses and analyzed the outcomes of those who underwent pulmonary resection. For the entire group of patients, factors predictive of survival in those patients with a diagnosis of pulmonary metastases included pulmonary resection of metastases (p = 0.0001), locoregional control of the head and neck primary tumor at the time of diagnosis of pulmonary metastases (p = 0.007), TNM stage of the head and neck primary tumor (p = 0.02), a single nodule seen on the chest radiograph (p = 0.02), and disease-free interval (DFI) from the primary tumor of the head and neck of 2 years or more (p = 0.05). Twenty-four of 58 patients underwent thoracotomy for resection of metastases. Four (17%) were found to have a second primary tumor of the lung. Of the 20 remaining patients who underwent explorative surgery for possible pulmonary resection, 18 (90%) underwent complete resection of all malignant disease with an estimated 5-year survival of 29%. In these patients, a DFI of less than 1 year was associated with a 5-year survival rate of 0%, whereas a DFI of 1 to 2 years was associated with a 5-year survival rate of 43% and a DFI of 2 years or longer had a 5-year survival rate of 33%. The number of malignant pulmonary nodules that were resected ranged from one to five and was not significant in predicting survival (p = 0.19). Of eight patients who underwent the resection of more than one malignant pulmonary nodule, 50% survived 2 years, but none survived 5 years. Resection of a solitary pulmonary metastasis from squamous cell carcinoma of the head and neck resulted in long-term survival in selected patients. Important prognostic factors included locoregional control of the head and neck primary tumor, the number of nodules seen on chest radiograph, the TNM stage of the primary tumor, and the DFI from the head and neck primary tumor. The value of resection in patients with more than one malignant pulmonary nodule remains to be defined for this group of patients.     

Palliative pulmonary resection for primary lung cancer]

From January 1961 through December 1984, 253 of 2048 patients who have undergone surgical treatment for primary lung cancer were retreated by palliative pulmonary resection. The indications of palliative resection were: there was partial carcinoma or metastatic lymph node left in the thorax; microscopically, residual tumor was found on bronchial stump margin. Operation modes: partial pulmonary resection 135, total pneumonectomy 118. Postoperative complications occurred in 25 cases and 17 died in the hospital with in 30 days. 236 cases were followed-up for 1 to 21 years. The 1-year, 3-year and 5-year survival rates after operation were 51.3%, 13.1% and 8.1% respectively. The survival rates after palliative pulmonary resection for squamous and adenocarcinoma were higher than thoracotomy but the survival rates of large undifferentiated, small cell and mixed cancer were similar to those of thoracotomy. Besides, patients who had both subcarinal lymph node involvement and incomplete excision in resection had the worst prognosis. The authors consider that squamous and adeno carcinoma of the lung are the main indication for palliative resection. Subcarinal lymph nodes must be excised as much as possible while operation, otherwise local radiation and/or chemotherapy should be performed after operation.     

Resection of recurrent pulmonary metastases in patients with soft-tissue sarcomas

Survival benefit and prognostic factors useful for patient selection have not been previously analyzed for patients with recurrent pulmonary metastases from soft-tissue sarcomas. Twenty-nine patients in our study had two or more resections of pulmonary metastases from 1976 to 1983. There were no operative deaths and three complications for 40 operations (7.5%). Factors predictive of increased survival following the second resection of pulmonary metastases were resectability and a disease-free interval of greater than six months from the first thoracotomy to the second recurrence in the lung. The tumor doubling time of the first recurrence and the presence of three or fewer nodules on full-lung tomography before the first thoracotomy, which were predictors of survival following initial resection, also predicted survival following subsequent resections. Overall median survival following the second resection was 14.5 months (22% overall three-year survival). The postresection actuarial survival curves for patients undergoing 1, 2, or 3 or more resections were not significantly different. Our findings demonstrate that patients undergoing repeated resections of pulmonary metastases from soft-tissue sarcomas can achieve prolonged survival.     

Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer

OBJECTIVE: The role of surgery in the treatment of patients with pulmonary and hepatic metastases from colorectal cancer has not been delineated. METHODS: Of the 351 patients enrolled in the Metastatic Lung Tumor Study Group of Japan between June 1988 and June 1996 who underwent thoracotomy for pulmonary metastases from colorectal cancer, 47 also underwent hepatic resection for metastatic tumors. The records of these patients were studied. RESULTS: The 47 patients who underwent pulmonary and hepatic resection had a 3-year survival of 36% +/- 8%, a 5-year survival of 31% +/- 8%, and an 8-year survival of 23% +/- 9%. The longest survival was 98 months. This patient was alive without recurrence. There was a significant difference in the cumulative survival of the patients with a solitary pulmonary metastasis and the patients with multiple pulmonary metastases (P =.04). Neither age, sex, location of the primary tumor, maximum diameter of the pulmonary metastases, method of pulmonary resection, number of hepatic metastases, nor method of hepatic resection was correlated with survival. However, 9 of 10 patients who survived 3 years or more after the initial thoracotomy had only one or two hepatic metastases. CONCLUSION: Surgical treatment of a solitary pulmonary metastasis concurrent with or after resection of hepatic metastases from colorectal cancer may be appropriate if the hepatic metastases are resectable for cure. Patients with a solitary pulmonary metastasis and a small number of hepatic metastases are good candidates for resection. Long-term survival can be expected.     

Pulmonary resection in children with metastatic osteogenic sarcoma: improved survival with surgery, chemotherapy, and irradiation.

Twelve consecutive unselected patients (aged 6 to 18 years) with osteogenic sarcoma underwent 19 thoracotomies for resection of pulmonary metastases. Wedge excisions of 41 metastatic nodules, one bilobectomy, and one pneumonectomy were performed. Six patients each required one thoracotomy, five patients underwent two thoracotomies, and one patient required three. Serious surgical complications were limited to one patient who required reoperation for closure of a bronchopleural fistula following bilobectomy. Initial pulmonary metastasis occurred 9 months (mean) after amputation (range 1 to 21 months). Complete excision of all identifiable metastatic tumor was possible in 17 of 19 thoracotomies. All patients received intensive cyclical chemotherapy after initial definitive amputation, after thoracotomy, or both. Tumor doubling time (TDT) during chemotherapy (mean 74 days) was significantly prolonged (p = 0.017) compared to TDT during intervals of no therapy (mean 22 days). Five patients received pulmonary radiotherapy prior to thoracotomy and five after thoracotomy. Four patients died during the observation period, having survived 10 to 30 months after amputation. Two patients are alive with known extrapulmonary metastases. Six patients are free of disease. The survival rate is 91.7 percent 1 year after amputation, 82.5 percent at 2 years, and 57.8 percent at 3 years. These results suggest improved survival when aggressive surgical resections of pulmonary metastases are combined with chemotherapy and radiotherapy. Thoracic surgical procedures in this group of patients are safe and associated with a low incidence of complications despite the potentially increased risks owing to antecedent chemotherapy and pulmonary irradiation.     

Surgical treatment in pulmonary metastases of colorectal cancer

From 1962 to 1987, 72 patients with primary colorectal cancer underwent surgical treatment for pulmonary metastases. The overall cumulative 5 year survival rate was 41.3%. But the cumulative 1 year survival rate of patients with incomplete resection was 20.0%. Reduction surgery should not be employed. Twenty-nine of 66 patients with complete resection have recurred. The most of first manifested recurrences were in the lung and within 18 months after thoracotomy. This tendency was remarkable in patients with multiple pulmonary metastases and all recurrences of them were within 18 months and 80% were multiple in bilateral lung. Almost all multiple pulmonary metastases seemed to be only one manifestation of generalized metastatic disease. So indication of surgical treatment for them should be cautious. Type of pulmonary resection had no influence on post-thoracotomy survival rate. But in patients with partial resection, 7 recurrences at surgical margin and one recurrence on regional lymph nodes were doubted. Four metastatic lesions less than 3cm in maximum diameter had metastases to the regional lymph nodes. To resect more curatively, lobectomy and systemic lymphadenectomy should be recommended as the standard operation for pulmonary metastases of colorectal cancer.     

The presence of colorectal hepatic metastases does not preclude pulmonary metastasectomy

Hepatic metastases due to colorectal carcinoma have often been felt to preclude pulmonary metastasectomy. With the recent advances in surgical options, should patients with both liver and lung metastases be considered for surgical resection? The current study reviews the impact of such aggressive management on disease-free and overall survival (OS). The clinical course of 63 patients presenting with colorectal metastasis to the lung alone (group 1, n = 45) or combined hepatic and lung metastases (group 2, n = 18) were reviewed. All patients underwent complete resection of their lung metastases. Surgical control of hepatic tumor burden was achieved by tumor ablation, intra-arterial therapy, and/or resection. All patients in group 1 and group 2 were available for a mean follow-up of 27 and 24 months, respectively. The presence of hepatic metastases, the resectability of hepatic tumor burden, and the disease-free interval after pulmonary metastasectomy did not significantly influence survival. These findings demonstrate that aggressive surgical management of pulmonary metastases in the presence of liver metastases offers a similar benefit as compared to patients with pulmonary metastases alone. Therefore, hepatic metastatic disease does not preclude an attempt at pulmonary metastasectomy if hepatic metastases can be resected or remains responsive to therapy. Such an approach achieves comparable OS and mean survival when compared to pulmonary metastasectomy alone.     

Preoperative chemotherapy and radiation therapy for stage IIIa carcinoma of the lung.

Thirty-six patients with stage IIIa histologically proven non-small cell carcinoma (T3 N2 or T2 N2) underwent concomitant radiation therapy and chemotherapy before pulmonary resection. The therapy consisted of two cycles of continuous infusion of cis-platinum, 25 mg.m-2.day-1 (days 1 through 4) every 4 weeks and concomitant irradiation, 55 Gy, of the tumor and mediastinum. Two to 3 weeks after treatment, the patients were reevaluated for thoracotomy and pulmonary resection. Five patients were found to have unresectable lesions. Thirty-one patients had complete resection, 27 by radical pneumonectomy and 4 by radical lobectomy, giving a resectability rate of 86%. Complete sterilization of lung tumor and mediastinal nodes proven histologically was achieved in 10 patients (28%) and 17 patients (47%). The 3-year survival rate is 61.7% for patients who had resection. Median follow-up is 27 months (range, 6 to 61 months). The preliminary study indicates that preoperative cis-platinum and concomitant radiation therapy is tolerated, appears to increase resectability, and may improve survival in patients with stage IIIa lung cancer.     

Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer

BACKGROUND: Multiple organ metastases from colorectal carcinoma may be considered incurable, but long survival after both liver and lung resection for metastases has been reported. METHODS: A retrospective analysis of 48 patients who underwent lung resection for metastatic colorectal cancer between 1992 and 1999 was undertaken. Twenty-seven patients had lung metastasis alone, 15 had previous partial hepatectomy, and six had previous resection of local or lymph node recurrence. The relationship of clinical variables to survival was assessed. Survival was calculated from the time of first pulmonary resection. RESULTS: Five-year survival rates after resection of lung metastasis were 73 per cent in patients without preceding recurrence, 50 per cent following previous partial hepatectomy and zero after resection of previous local recurrence. Independent prognostic variables that significantly affected survival after thoracotomy were primary tumour histology and type of preceding recurrence. There was no significant difference in survival after lung resection between patients who had sequential liver and lung resection versus those who had lung resection alone. CONCLUSION: Sequential lung resection after partial hepatectomy for metastatic colorectal cancer may lead to long-term survival.     

The role of thoracotomy in the management of pulmonary metastases from malignant melanoma.

Thirty-three patients over a 21-year period underwent thoracotomy for resection of suspected pulmonary metastases from malignant melanoma. Eleven patients were found to have nonmalignant disease (Group 1); 10 were found to have unresectable disease (Group 2); and 12 were rendered disease-free (Group 3). Of the patients found to have melanoma, 20 of 22 received post-operative chemotherapy. The median survival of the patients in Group 2 was 10.5 months (3 to 20 months); in Group 3 it was 12 months (3 to 35 months). There were no 5-year survivors. No factors distinguished the three groups preoperatively. Surgical resection still offers the greatest chance for long-term survival, based on reports of patients in the literature who have survived longer than 5 years following resection of pulmonary metastases from melanoma. Thoracotomy is especially useful for staging purposes in those patients found to have no metastatic disease.     

Surgical resection of unilateral lung metastases: is bilateral thoracotomy necessary?

urgical resection of lung mestastases is routine procedure for selected patients with pulmonary nodules and solid tumors. In some cases, patients present with unilateral pulmonary metastases amenable to surgical resection. Surgeons are still divided between unilateral approach directed to the radiologically detected nodules, or bilateral exploratory thoracotomy. This study evaluates the need for bilateral thoracotomy in patients diagnosed with unilateral lung metastases. A retrospective evaluation was made of a prospective database from a single institution (1990–1997) of all consecutive patients (n = 267) diagnosed on admission with unilateral (n = 179) or bilateral (n= 88) lung nodules. Ipsilateral thoracotomy was performed on all patients with unilateral disease. Bilateral thoracotomy was performed on all patients with bilateral lung metastases. Histology: adenocarcinoma (25%), osteosarcoma (23%), squamous cell carcinoma (18%), soft-tissue sarcoma (18%), and other (16%). Median follow-up was 17 months. Contralateral disease-free survival and overall survival were determined. Univariate and multivariate analyses were performed to determine prognostic factors for overall and contralateral disease-free survival. The two groups of patients with confirmed bilateral metastases (synchronous or metachronous) were compared. Actuarial overall 5-year survival was 34.9%. Contralateral recurrence-free 6-month, 12-month, and 5-year survival were 95%, 89%, and 78%, respectively. Patients who experienced recurrence in the contralateral lung within 3, 6, or 12 months had an overall 5-year survival rate of 24%, 30%, and 37%, respectively. When patients with recurrence in the contralateral lung were compared to patients with bilateral metastases on admission, there was no significant difference in overall survival. Only histology and the number of pathologically proven metastases significantly (p <0.05) predicted recurrence in the contralateral lung. Bilateral exploration of unilateral lung metastases is not warranted in all cases. Most patients will have only unilateral disease, and delaying contralateral thoracotomy until disease is detected radiologically does not appear to affect outcome.     

Repeat Pulmonary Resection for Isolated Recurrent Lung Metastases Yields Results Comparable to Those after First Pulmonary Resection in Colorectal Cancer

Pulmonary resection for colorectal metastases is well accepted. However, the main cause of death after pulmonary resection is recurrence in the lung. The aim of this study was to clarify whether a repeat pulmonary resection was warranted in patients with recurrent lung metastases. The records of 76 patients undergoing initial pulmonary resection, including 14 patients undergoing a repeat operation for lung metastases, were reviewed for survival, operative morbidity, and mortality. Overall, pulmonary resection was performed 96 times in this group of patients. The operative mortality was 0%, morbidity involved only one case of major postoperative hemorrhage associated with the first operation. The cumulative 5-year survival rate for the 76 patients was 32%. After the second pulmonary operation, recurrence was identified in 79% (11 of 14) of the patients. In 10 patients with isolated lung recurrence after a first pulmonary resection, who showed no extrapulmonary disease before or at the time of first thoracotomy, the 3-year, and 5-year-survival rate after the second pulmonary resection was 67%, and 33%, respectively, comparing favorably with the survival rate in those who underwent primary pulmonary resection. In contrast, all 4 patients with extrapulmonary disease before or at the time of thoracotomy had poor prognosis. Repeat pulmonary operation for isolated recurrent colorectal metastases to the lung yielded results comparable to those after the first pulmonary resection in terms of operative mortality and survival in the absence of hilar/mediastinal lymph node or extrathoracic involvement.     

Does Surgical Resection of Pulmonary Metastases of Head and Neck Cancer Improve Survival?

Background  The prognosis of patients with metastasized head and neck cancer is poor. Limited experience exists with the benefit of resection of lung metastases and systematic mediastinal and hilar lymph node dissection on survival of patients with head and neck carcinoma. Methods  Eighty patients undergoing metastasectomy for pulmonary metastases of primary head and neck cancer entered the study. Multivariate analysis was performed by Cox regression analysis. Survival differences between patients operated and those not operated on were analyzed by matched pair analysis. Results  From 1984 until 2006, pulmonary metastases were diagnosed in 332 patients treated for head and neck cancer; 80 of these were admitted to our department for resection. Metastases of the primary head and neck tumor were confirmed histologically in 67 patients. The median overall survival after resection of lung metastases was 19.4 months and was statistically significantly better compared with patients who were not operated on (P < .001). The multivariate analysis after metastasectomy revealed that incomplete resection of pulmonary lesions, complications associated with surgery, and adjuvant therapy of the primary tumor are independent negative prognostic factors for survival. We observed a trend to improved survival in patients without hilar or mediastinal lymph node metastases. Conclusion  The survival rate of patients operated on was statistically significantly higher than that of patients with conservative treatment. Even patients with multiple or bilateral pulmonary lesions after curative treatment of a primary tumor should be operated on if there is no contraindication against an extended surgical procedure and a complete resection of the metastases seems achievable. The first two authors contributed equally to this work.