Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma

BACKGROUND: Pulmonary resection in metastatic renal cell carcinoma is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome, and prognostic factors after surgery. METHODS: Between 1985 and 1999, 191 patients (145 men, 46 women) with pulmonary metastases from a renal cell carcinoma underwent surgical resection. Inclusion criteria for the study were the absence of primary tumor recurrence and other extrapulmonary metastases. Complete resection (CR) was achieved in 149 patients. RESULTS: The overall 5-year survival rate was 36.9%. The 5-year survival rate after complete metastasectomy and incomplete resection was 41.5% and 22.1%, respectively. In patients with pulmonary or mediastinal lymph node metastases, we observed after complete resection a 5-year survival rate of 24.4%, whereas the rate was 42.1% in patients without lymph node involvement. A significantly longer survival was observed for patients with fewer than seven pulmonary metastases compared with patients with more than seven metastases (46.8% vs 14.5%). For surgically rendered complete resection (CR) patients with a disease-free interval of 0 to 23 months, the 5-year survival rate was 24.7% compared with 47% for those with more than a 23-month disease-free interval. By multivariate analyses, we showed that the number of pulmonary metastases, the involvement of lymph node metastases, and the length of the disease-free interval were all predictors of survival after complete resection. CONCLUSIONS: We conclude that pulmonary resection in metastatic renal cell carcinoma is a safe and effective treatment that offers improved survival benefit. Prognosis-related criteria are identified that support patient selection for surgery.     

Pulmonary resection for metastasis from esophageal carcinoma

Pulmonary metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, few data have been available regarding lung metastasectomy for esophageal carcinoma. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. Between 2001 and 2007, five patients with pulmonary metastases from esophageal carcinoma underwent complete pulmonary resection. All patients had undergone curative resection of their primary esophageal carcinomas and also had obtained locoregional control of their primaries. Disease-free interval varied from 13 to 56 months, with a median of 21 months. In three patients, lung metastases were found to be unilateral and solitary. The other two patients presented several metastases in the unilateral or bilateral lungs. All patients underwent wedge resection or segmentectomy. Currently, four patients are alive without evidence of disease and one patient has died of disease. All patients undertook or were going to undertake chemotherapy after the pulmonary metastasectomy. Three patients with solitary metastasis are all alive without disease 13, 48, and 90 months after the first pulmonary metastasectomy, respectively. Pulmonary metastasectomy for esophageal carcinoma with postoperative chemotherapy was seemingly justified. Solitary pulmonary metastasis might be a good candidate for favorable prognostic factor.     

Pulmonary Resection for Metastatic Head and Neck Cancer

BACKGROUND: Pulmonary metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, little data have been available about lung metastasectomy for head and neck cancers. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. METHODS: Between 1991 and 2007, 20 patients with pulmonary metastases from head and neck cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Various perioperative variables were investigated retrospectively to analyze the prognostic factors for overall survival and disease-free survival after metastasectomy. RESULTS: Of the 20 patients, 10 (50%) had squamous cell carcinoma, 7 (35%) had adenoid cystic carcinoma, and 3 had miscellaneous carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Overall survival rate after metastasectomy was 59.4% at 5 years and 47.5% at 10 years, respectively. Disease-free survival rate was 25.0% at 5 years after pulmonary resection. A disease-free interval equal to or longer than 12 months was a significantly favorable prognostic factor for both overall survival and disease-free survival (p = 0.02 and 0.01, respectively). Patients with squamous cell carcinoma and male sex showed a worse overall survival (p = 0.04 and 0.03, respectively). CONCLUSION: The current practice of pulmonary metastasectomy for head and neck cancers in our institution was well justified. A disease-free interval equal to or longer than 12 months, nonsquamous cell carcinoma, and female sex might be relevant to a better prognosis.     

Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma

OBJECTIVE: Pulmonary metastasectomy as well as immunotherapy have reproducible, albeit limited efficacy in advanced renal cell carcinoma (RCC). We examined whether metastasectomy improved overall survival compared with results of immunotherapy. METHODS: Between 1975 and 2003, 64 patients (41 men, 23 women) underwent pulmonary resection of metastatic RCC. Only patients who met the criteria for potentially curative operation, that means, control of primary tumor, ability to resect metastatic disease and no other extrapulmonary metastases, were included. RESULTS: The overall 5-year survival was 33.4% (median survival: 39.2 months). A significant longer survival was observed using multivariate analysis in patients with complete pulmonary resection (R0), with a 5-year survival of 39.9% and a median survival of 46.6 months in correlation to patients with incomplete resection (5-year survival 0%, median survival 13.3 months). In multivariate analysis patients with synchronous metastases had a significant worse prognosis in correlation to patients with metachronous metastases. The 5-year survival of curative resected patients with metachronous metastases was 43.7% versus 0% for synchronous metastases, respectively. In patients with solitary metastasis and R0 resection, we observed a 5-year survival of 49%, whereas the rate was 23% in patients with more than a single metastasis. When establishing prognostic groups as suggested by the International Registry based on the risk factors disease-free interval, number of metastasis and complete resection the group with the best prognosis showed a 5-year survival of 52% (median survival 75.2 months). CONCLUSION: Metastasectomy nowadays is the best treatment option in cases with technical resectable metastases with as much as possible good prognostic factors (metachronous metastases with long DFI, number up to 6 metastases).     

Pulmonary metastasectomy of renal cell carcinoma: Local experience

Objective: Up until now, the prognosis of a patient with disseminated renal cell carcinoma is poor with 5‐year survival less than 2%. In a small subset of patients with isolated pulmonary metastasis, long‐term survival after pulmonary metastasectomy has been reported to be acceptable. The purpose of the present study was to evaluate the result of pulmonary metastasectomy in a local cardiothoracic surgical centre. Methods: Patients who had renal cell carcinoma and pulmonary metastasectomy for isolated pulmonary metastasectomy were recruited for the study. Their survival was analysed. Results: Between 1992 and 2004, 13 patients underwent 15 operative procedures for pulmonary metastases from renal cell carcinoma. The median follow up was 39.8 months (from 4.6 to 127.5 months). The five‐year survival after pulmonary metastasectomy was 48.3% and median survival was 25.4 months. There was no postoperative mortality. Pulmonary recurrence was the commonest recurrent site after pulmonary metastasectomy. Conclusion: Pulmonary metastasectomy for renal cell carcinoma is a safe and effective procedure. And, as the lung is the commonest site of first recurrence after pulmonary metastasectomy, the present study on the control of these occult metastases is necessary.     

Prognostic Factors of Pulmonary Metastasectomy for Colorectal Carcinomas

Background  Pulmonary metastasectomy for colorectal carcinoma is a well-accepted procedure; however, reports on indications and prognostic factors are inconsistent. This study was designed to clarify a role for resection of pulmonary metastases for such tumors and to define the patients who benefit from pulmonary metastasectomy. Methods  Between 1990 and 2007, 84 patients with pulmonary metastases from colorectal carcinomas underwent curative pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary tumors. Various perioperative variables were investigated retrospectively to confirm a role for metastasectomy and to analyze prognostic factors for overall survival and disease-free survival after metastasectomy. Results  Overall survival rate after metastasectomy was 60.5% and 48.4% at 5 and 10 years, respectively. Disease-free survival rate was 34.4% and 30.6% at 5 and 10 years after pulmonary resection, respectively. On multivariate analysis, patients with unilateral pulmonary metastasis presented a significantly favorable overall survival (P = 0.045). In contrast, there was no significant prognostic factor for disease-free survival. Conclusions  Current practice of pulmonary metastasectomy for colorectal carcinoma in our institution was well justified. Our study confirmed that unilateral pulmonary metastasis was significantly relevant to a better prognosis.     

肺转移瘤的诊断与外科治疗

目的探讨肺转移瘤的诊断、手术指征、切除方式及影响预后的因素,以提高患者的生存率。方法125例肺转移瘤患者均行手术治疗,共行肺转移瘤切除术138次,其中行一次手术116例,二次手术5例,三次手术4例。手术方式为肺部分切除66次,肺段切除2次,肺叶切除53次,肺叶加部分胸壁扩大切除2次,全肺切除3次,肿瘤剜除12次;行开胸手术130次,电视胸腔镜手术（VATS）8次。结果本组患者中原发肿瘤为上皮组织来源的94例,肉瘤类26例,其它种类5例。全组患者无围术期死亡,随访122例,随访时间1～10年,1年、3年和5年生存率分别为90．4％、53．3％和34．8％;其中结、直肠癌、肾癌和软组织肉瘤的预后较好,5年生存率分别为43．8％、37．5％和33．3％。105例肺转移瘤完全切除患者的5年生存率为38．9％,20例不完全切除患者为16．7％。89例行常规肺门及纵隔淋巴结摘除患者仅有12例术后病理证实有淋巴结转移,无淋巴结转移患者和有淋巴结转移患者的5年生存率分别为41．5％和14．3％。结论对诊断明确、符合标准的肺转移瘤患者行积极的手术治疗可取得满意的效果,手术径路以后外侧小切口为主,能否完全切除肿瘤和肺门纵隔淋巴结的转移状况是影响预后的重要因素。     

Synchronous pulmonary metastases from renal cell carcinoma - a whole nation study on prevalence and potential resectability

Background: At the time of diagnosis, almost one third of patients with renal cell carcinoma (RCC) have metastasis. We studied the prevalence, survival, and potential resectability of syn-chronous pulmonary metastases (SPMs) in a well-defined cohort of RCC patients.Material and Methods: A retrospective whole nation study including RCC patients with SPM diagnosed 1970-2005 in Iceland. Imaging studies and histology were reviewed, the TNM sys-tem used for staging the primary tumors, and disease-specific survival estimated. Eligibility for SPM removal was evaluated using different criteria from the literature on surgical management of SPM, including solitary SPM and SPMs confined to one lung.Results: Altogether, 154 patients (16.9%) had SPMs. In 55 of these patients (35.7%) the lungs were the only site, with detailed information available in 46 cases. Of these 46 patients with SPMs, 15 were unilateral, and of those 11 were solitary. All of these 11 patients were in good physical condition and were deemed eligible for surgical resection; however, only one of them was operated with metastasectomy. Disease-specific survival at five years for patients with so-litary SPM was 27.2%, as compared to 12.7%, 7.1%, and 12.0% for patients with unilateral SPMs, all patients with SPMs, and patients with extrapulmonal metastases, respectively (p?=?0.33).Conclusion: At the time of diagnosis, 16.9% of RCC patients had SPM. In one in three of these SPM patients metastases were confined to the lungs, while one in five had solitary pulmonary metastases. Although the benefit of pulmonary metastasectomy in RCC is still debated and criteria for resection are not well defined, it appears that many RCC patients with SPM are potentially eligible for pulmonary metastasectomy.     

Surgical approach to pulmonary metastases from breast cancer

Abstract: One of the main characteristics of breast cancer is its capability to disseminate. Solitary pulmonary metastases from breast cancer occur rarely (0.4%). The aim of this study is to check whether or not the outcome following the surgical treatment of pulmonary metastases in patients with breast cancer is in accordance with the data in the literature and based on it to identify prognostic factors. We have reviewed retrospectively data for 33 patients who underwent 43 curative resections of breast cancer pulmonary metastases between 1997 and 2002 at our department. Potential prognostic factors affecting survival, namely survival after lung metastasectomy, assessed were disease‐free interval (DFI), the number and location of lung metastases, the diameter in mm of metastases and the extent of pulmonary resection. The median survival for 33 patients with pulmonary breast cancer metastatic lesions after metastasectomy was 73.2 months. Mean 5‐year survival was 54.5%. There was a statistically significant difference in survival time with better prognosis for patients with DFI > 36 months (p = 0.0007), complete metastasectomy (p = 0.0153), unilateral pulmonary metastases (p = 0.0267) and for patients who underwent multiple operations (p = 0.0211). In multivariate analysis there was significant influence for long‐term prognosis for patients with DFI > 36 months (p = 0.0446) and for complete resection of the metastases (p = 0.0275). Analysis of the survival rates for patients with solitary pulmonary metastasis, with different size of tumors and after different types of pulmonary resection showed no significant differences. It was concluded that resection of lung metastases from breast cancer may offer a significant survival benefit for selected patients. The identified prognostic factor for survival after metastasectomy is DFI longer than 36 months and complete resection of the metastases. In our group of patients, DFI longer than 36 months, unilateral pulmonary metastases and number of operations significantly influenced survival. Also, the results showed that lung metastasectomy by conventional surgery is a safe procedure with low perioperative morbidity and mortality rate.     

Pulmonary Resection for Metastases from Hepatocellular Carcinoma

BACKGROUND: Pulmonary metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, few data have been available about lung metastasectomy for hepatocellular carcinoma. To confirm the role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. METHODS: Between 1993 and 2005, 12 patients with pulmonary metastases from hepatocellular carcinomas underwent complete pulmonary resection. All patients had undergone curative resection of their primary hepatocellular carcinomas and also had obtained or had obtainable locoregional control of their primaries. Various perioperative variables were investigated retrospectively to analyze the possible prognostic factors for overall survival and pulmonary metastases-free survival after pulmonary metastasectomy. RESULTS: Nine patients were male and three were female (median age, 53 (range, 43-80) years). Overall survival rate after metastasectomy was 80.8%, 57.7%, and 28.9% at 1, 2, and 5 years, respectively. Pulmonary metastases-free survival rate was 64.2%, 32.1%, and 21.4% at 1, 2, and 5 years, respectively. Five patients presented recurrences in the remaining liver before pulmonary metastases, but hepatic recurrences at this interval did not affect an overall survival after pulmonary metastasectomies. Two patients had undergone living-related liver transplantation. The maximum tumor size of the pulmonary metastasis < 3 cm was the only favorable prognostic factor for overall survival (P = 0.0006), whereas there was no significant prognostic factor for pulmonary metastases-free survival. CONCLUSIONS: Pulmonary metastasectomy for hepatocellular carcinoma in selected patients was well justified when the maximum tumor size was <3 cm.     

Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment

OBJECTIVE: The purpose of this study was to analyze our entire experience with pulmonary resection for metastatic colorectal carcinoma to determine prognostic factors and critically evaluate the potential role of extended metastasectomy. METHODS: We analyzed the postoperative survival of 165 patients who underwent curative pulmonary surgery at eight institutions in the Kansai region of western Japan (Kansai Clinical Oncology Group) from 1990 to 2000. RESULTS: Overall survivals at 5 and 10 years were 39.6% and 37.2%, respectively. Cumulative survival of patients who underwent simultaneous bilateral metastasectomy was significantly lower than that of the patients who underwent unilateral metastasectomy or sequential bilateral metastasectomy (P =.048). Five-year survival was 53.6% for patients without hilar or mediastinal lymph node metastasis, versus 6.2% at 4 years for patients with metastases (P <.001). Five-year survival of patients with a prethoracotomy carcinoembryonic antigen level less than 10 ng/mL was 42.7%, versus 15.1% at 4 years for patients with a carcinoembryonic antigen level 10 ng/mL or greater (P <.0001). Twenty-one patients underwent a second or third thoracotomy for recurrent colorectal carcinoma. Overall 5-year survival from the date of the second thoracotomy was 52.1%. The 34.1% 10-year survival for the 26 patients with hepatic metastasis resected before thoracotomy did not differ significantly from that of patients without hepatic metastases (P =.38). CONCLUSIONS: The status of the hilar or mediastinal lymph nodes and prethoracotomy carcinoembryonic antigen level were significant independent prognostic factors. Patients with pulmonary metastases potentially benefit from pulmonary metastasectomy even when there is a history of solitary liver metastasis. Careful follow-up is warranted, because patients with recurrent pulmonary metastases can undergo repeat thoracotomy with acceptable long-term survival. Simultaneous bilateral metastasectomy confers no survival benefit. Prospective studies may determine the significance of this type of pulmonary metastasectomy.     

Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma

Background

A pulmonary metastasectomy for colorectal carcinoma is a generally accepted procedure, although several prognostic predictors have been reported. The aim of this study is to define the patients who benefit from pulmonary metastasectomy for colorectal carcinoma.

Methods

Retrospective survival analysis was performed using 128 patients who underwent curative pulmonary resection.

Results

The overall 5-year survival rate was 45.3%. Univariate analysis showed the number of metastases, location (unilateral or bilateral), prethoracotomy carcinoembryonic antigen (CEA) level, hilar or mediastinal lymph-node metastasis, and Dukes' stage to be considerable prognostic factors. Among these, Dukes' A for the primary lesion and unilateral pulmonary metastasis were shown to be independent predictors of longer survival by multivariate analysis (p = 0.0093 and p = 0.0182, respectively). In patients treated with both pulmonary and hepatic metastastasectomies, a better prognosis was observed in those who received metachronous resection. Recurrence after a pulmonary metastasectomy frequently occurred in the thorax and the 3-year survival rate was 44.6% in patients who underwent a repeat thoracotomy.

Conclusions

Patients with unilateral metastasis and Dukes' A for the primary tumor benefit most from the resection of pulmonary metastasis from colorectal carcinoma. Further, the number of metastases, prethoracotomy CEA level, and hilar or mediastinal lymph-node involvement should be considered to determine the operative indication. Finally, periodic follow-up examinations for thoracic recurrence should be carefully performed as these patients may have a heightened risk of requiring a repeat thoracotomy.     

Surgical treatment of hepatic and pulmonary metastases from colon cancer

BACKGROUND: Surgical resection of isolated hepatic or pulmonary metastases secondary to colorectal cancer has been shown to yield acceptable long-term survival. However, results are inconclusive for surgical resection of both hepatic and pulmonary metastases. METHODS: We reviewed the records of all patients who underwent surgical resection of both hepatic and pulmonary metastases from colorectal cancer between 1980 and 1998. RESULTS: A total of 58 patients underwent resection of both hepatic and pulmonary metastases secondary to colorectal cancer. All patients had local control of their primary cancer before metastasectomy. There were no operative deaths. Morbidity occurred in 12% of patients. Follow-up was complete in all patients, with a median duration of 62 months (range, 6 to 201 months). The 5- and 10-year survivals were 30% and 16%, respectively. A premetastasectomy carcinoembryonic antigen level greater than 5 ng/mL increased the risk of early death (p = 0.029). Neither the number of pulmonary lesions nor the time interval between the primary surgery and the metastasectomy had a significant impact on survival (p = 0.67). At 5 years, 55% of patients were free of disease. Four patients had lymph node involvement at the time of pulmonary resection and all 4 patients died within 22 months of their pulmonary metastasectomy. CONCLUSIONS: Resection of both hepatic and pulmonary metastases secondary to colorectal cancer in highly selected patients is safe and results in long-term survival. Thoracic lymph node involvement and elevated carcinoembryonic antigen levels before pulmonary metastasectomy are associated with reduced survival.     

Multiple Repeat Resections of Intra- and Extrahepatic Recurrencesin Patients Undergoing Initial Hepatectomy for Colorectal CarcinomaMetastases

Recent evidence suggests that single repeat metastasectomy may provide survival benefits for selected patients experiencing hepatic or pulmonary recurrences following initial hepatectomy for colorectal carcinoma metastases. The aim of this retrospective study was to clarify the efficacy of multiple repeat resections of intra- and extrahepatic recurrences following initial hepatectomy. A total of 100 patients underwent curative partial hepatectomy as the initial procedure for colorectal carcinoma metastases. Tumor relapse after initial hepatectomy was seen in 72 patients, of whom 28 underwent 45 repeat metastasectomies of various sites: 18 patients underwent a single repeat metastasectomy, and 10 underwent multiple repeat metastasectomies. The overall survival rate at 5 years after initial hepatectomy was 36.6%, while the 5-year survival rate after repeat metastasectomy in the 28 patients was 43.6%. The outcome of initial hepatectomy was comparable with that of repeat metastasectomy (p = 0.6924). Among the 28 patients undergoing repeat metastasectomy, the outcome of resection of intrahepatic recurrences in 11 patients was comparable with the outcome of resection of extrahepatic recurrences in 17 patients(p = 0.3926). The outcome of multiple repeat metastasectomies compared favorably with single repeat metastasectomy(p = 0.1803). Multivariate analysis(p < 0.0001) showed that repeat metastasectomy was the strongest prognostic factor. In conclusion, both single and multiple repeat resections of intra- and extrahepatic recurrences after initial hepatectomy are efficacious in colorectal carcinoma patients.Repeat resection should be considered for any resectable recurrences after hepatectomy.     

食管癌术后肺转移瘤的外科治疗效果及预后影响因素分析

目的探讨食管癌术后肺转移瘤的外科治疗效果及其预后影响因素。方法回顾性分析1994年3月至2008年5月徐州市第一人民医院和河北大学附属医院收治的食管癌术后肺转移瘤患者15例的临床资料,男10例、女5例,年龄43~72（65.0±8.8）岁。手术方式为肺部分切除术、肺楔形切除术、肺段切除术及肺叶切除术。随访时间60个月,分析转移瘤数目及大小、原发瘤TNM分期及无瘤生存时间（DFI）对肺转移瘤患者术后生存率的影响。结果肺转移瘤患者术后12、24、60个月的生存率分别为80.0%、66.7%和6.7%,患者术后中位DFI为30个月,DFI≥24个月肺转移瘤患者的术后生存率明显高于DFI〈24个月者（χ2=5.144,P=0.023）。肺单发转移患者的术后生存率明显高于肺多发转移患者（χ2=3.990,P=0.046）。而肺转移瘤大小和原发瘤TNM分期对肺转移瘤患者术后生存率无明显影响（P〉0.05）。Cox比例风险模型分析DFI是影响肺转移瘤患者术后生存率的主要因素（P=0.026）。结论外科手术是治疗食管癌术后肺转移的手段之一,尤其在肺单发转移瘤和食管癌术后DFI〉24个月的患者手术切除效果可能更佳。     

Evaluation of video-assisted thoracoscopic surgery for pulmonary metastases: 11-years of experience

Background  Although video-assisted thoracoscopic surgery (VATS) has been applied to pulmonary resection for pulmonary metastases, the clinical validity of this approach remains controversial. The purpose of this study was to evaluate the validity and problems of VATS for pulmonary metastasectomy. Methods  From January 1993 to December 2003, VATS for pulmonary metastasectomy was performed in 53 resections for 48 patients at our institution. The medical records of these patients were retrospectively reviewed. Results  The primary tumor was colorectal cancer in 23 patients, renal cell carcinoma in 6, breast cancer in 6, germ cell tumor in 5, head and neck cancer in 2, and others in 6. Thirty-six cases had a solitary lesion, 8 had unilateral multiple lesions, and 9 had bilateral multiple lesions. The following procedures were performed: 7 lobectomies, 5 segmentectomies, and 41 wedge resections. There was no major postoperative morbidity related to VATS. At a median follow-up period of 29.0 months, 13 patients were alive without recurrences. The 3-year overall survival rate and the 3-year intrathoracic disease-free survival rate were 59.8% and 33.4%, respectively. Five cases had recurrence at the surgical stump or at the port sites, but these recurrences have not been found in the recent period since June 1997. Intrathoracic recurrences within 3 months after VATS occurred in four. Conclusion  VATS for pulmonary metastases is not superior to the conventional open thoracotomy and is not recommended as a standard procedure. Further studies with a larger number of cases performed by skilled surgeons familiar with VATS are needed.     

Pulmonary metastasectomy for uterine cervical cancer: a multivariate analysis

BACKGROUND: This study evaluated the results of resection of pulmonary metastases from cervical cancer. METHODS: A total of 7,748 patients with primary stage Ib or II cervical cancer underwent curative initial treatment consisting of radical hysterectomy or radiotherapy in 22 hospitals. Of the 7,748 patients, 29 (0.37%) patients had pulmonary metastases, which were detected after a disease-free period after initial treatment (radical hysterectomy or radiotherapy) and were resected with the intention to cure by June 30, 1998. RESULTS: The 5-year disease-free survival rate after pulmonary metastasectomy for all patients was 32.9%. Patients with one or two pulmonary metastases had a 5-year disease-free survival rate of 42.2% compared with 0% for patients with three or four metastases (p = 0.0003). Patients with squamous cell cancers had a 5-year disease-free survival rate of 47.4% compared with 0% for patients with adenosquamous cell cancers or adenocarcinoma (p = 0.0141). On multivariate analysis, the significant prognostic variables for disease-free survival were two or fewer metastases (p = 0.0232) and squamous cell cancer (p = 0.0168). CONCLUSIONS: Cervical cancer patients with pulmonary metastases after initial treatment (radical hysterectomy or radiotherapy) could expect to achieve long-term disease-free survival by pulmonary metastasectomy when there are two or fewer metastases diagnosed as squamous cell cancer.     

Consideration of the prognostic factors influencing survival after lung metastasectomy of renal cell carcinoma

From 1989 to 2002, 9 patients with metastatic renal cell carcinoma to lung underwent lung resections for curative removal of metastatic disease in our department. Disease free interval (DFI), number and size of metastases resected (at first metastasectomy), and number of metastasized regional lymph nodes were studied after resection of pulmonary metastases. DFI were 0 to 60 months with mean value of 23 months. At first operation, single metastases accounted for 4 cases and multiple lesions more than 2 metastases accounted for 5 cases with mean value of 2.1. Maximal diameter of metastases was 10 to 50 mm with mean value of 24 mm. Regional lymph nodes metastases were demonstrated only 1 patient in 2 of No. 12 lymph nodes adjacent to metastases. At subsequent relapse, 1 patient had second-stage metastasectomy, 2 patients went on to a third phase. Four patients were lost, 2 are under treatment for newly relapsed lesions, and 3 are now free of metastases. Analysis was performed by Cox proportional hazards model of survival using these factors. Though lacking the statistical significance, only maximal diameter of metastases was prone to have influencing factor on prognosis. Survival was not related to DFI between 0 to 21 months and more than 21 months and numerous lung metastases between single metastasis and with 2 or more. In general, estimated survival rate of these patients according to Kaplan-Meier was 0% at 67 months. Considering the above results, surgical treatment for patients with metastatic renal cell carcinoma to lung should be planned carefully.     

Outcomes After Hepatic and Pulmonary Metastasectomies Compared With Pulmonary Metastasectomy Alone in Patients With Colorectal Cancer Metastasis to Liver and Lungs

Background

Surgical resection is the most effective treatment for colorectal cancer that has metastasized to the liver. Similarly, surgical resection improves survival for selected patients with pulmonary colorectal metastases. However, the indication for pulmonary metastasectomy is not clear in patients with both hepatic and pulmonary colorectal metastases. Therefore, we evaluated outcomes after pulmonary resection of colorectal metastases in patients with or without a history of curative hepatic metastasectomy.

Methods

We retrospectively analyzed 96 patients who underwent pulmonary metastasectomy from March 1999 to November 2009. Patients were grouped according to treatment: resection of pulmonary metastases alone (lung metastasectomy group) or resection of both hepatic and pulmonary metastases (liver and lung metastasectomy group). Overall survival (OS) and disease-free survival (DFS) were evaluated by Kaplan–Meier analysis. Survival curves were compared using the log-rank test.

Results

The 5-year OS for all patients was 61.3 %, and the 5-year DFS was 26.7 %. Group comparisons showed that the 5-year OS of the lung metastasectomy group was significantly better than that of the liver and lung metastasectomy group (69 vs. 43 %; p = 0.030). However, the 5-year DFS rates of the lung metastasectomy group (25.8 %) and liver and lung metastasectomy group (28.0 %) did not differ significantly. Recurrence was higher after resection of both hepatic and pulmonary metastases than after pulmonary metastases alone (79 vs. 45 %; p = 0.025).

Conclusions

Resection of pulmonary colorectal metastases may increase survival. However, the combination of liver and lung metastasectomies had a worse prognosis than pulmonary metastasectomy alone. In selected patients, combined liver and lung metastasectomy can be beneficial and result in acceptable DFS.     

Pulmonary Metastasectomy for Head and Neck Cancers

Background: Distant metastases from carcinomas that arise from the head and neck region are infrequent. The most common site is the lung. To evaluate the results of resection of pulmonary metastases for head and neck cancers, we reviewed our own cases of these metastases.Methods: Between November 1966 and March 1995, 83 patients with pulmonary metastases from head and neck cancers underwent 94 thoracic operations. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Kaplan-Meier and Cox regression models were used to analyze the prognostic factors for survival after metastasectomy.Results: Median age was 53 years (range, 17–77). Fifty-nine were male and 24 were female. Forty-one patients had squamous cell cancers, and 36 had glandular tumors that consisted mostly of thyroid and adenoid cystic carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Sixty-eight (82%) patients had complete resection. Overall operative mortality rate was 2%. Overall actuarial survival rate after metastasectomy was 50% at 5 years. Patients with glandular tumors had a 5-year survival rate of 64% compared with 34% for patients with squamous cell cancers. When the patients with glandular tumors were analyzed according to their histology, patients with adenoid cystic carcinomas had an 84% 5-year survival, but none remained disease-free. Patients with thyroid cancers fared similarly whether they were treated medically or surgically. On multivariate analysis, the adverse prognostic factors for patients with squamous cell cancers were incomplete resection, age greater than 50 years, and disease-free interval less than or equal to 2 years.Conclusions: Approximately 30% of patients with pulmonary metastases from squamous cell cancers of the head and neck who underwent complete resection of all their metastases can expect to achieve long-term survival. The role of pulmonary resection for patients with glandular tumors is unclear.Presented in part at the 51st Annual Symposium Meeting of the Society of Surgical Oncology, San Diego, March 26–29, 1998.