Surgical indication for non-small cell lung cancer with synchronous distant metastases

From 1989 to 2004, 20 patients with synchronous distant metastases [intrapulmonary metastases (n=10) and extrapulmonary metastases (n=10)] underwent surgery for primary lesion of non-small cell lung cancer (NSCLC). Complete resection of the primary tumor and metastases was achieved in 5 patients. Overall 1- and 2-year survival rates were 48 and 11%, respectively, and mean survival was 21 months. The corresponding figures for patients with pulmonary metastasis to another lobe were 78, 23%, and 35 months, and those for patients with distant metastasis to a site other than another pulmonary lobe were 20, 0%, and 7 months. Two patients with pulmonary metastasis survived more than 5 years. With pulmonary metastasis to another lobe prognosis was better than that with distant metastasis to another site. Survival was not affected by histology or N factor. Complete resection tended to be a factor contributing to a better clinical outcome. This study suggests that surgery for NSCLC with synchronous distant metastasis should be indicated only for patients who could be expected to undergo complete excision of both the primary and metastasis lesion, as a clinical study under informed consent.