Long-term results of lung metastasectomy: Prognostic analyses based on 5206 cases

U. Pastorino, M. Buyse, G. Friedel, R. J. Ginsberg, P. Girard, P. Goldstraw, M. Johnston, P. McCormack, H. Pass, Jr Putnam J.B., V. W. Rusch, S. Nazari

Research output: Contribution to journalArticle

Abstract

Objectives: The International Registry of Lung Metastases was established in 1991 to assess the long-term results of pulmonary metastasectomy. Methods: The Registry has accrued 5206 cases of lung metastasectomy, from 18 departments of thoracic surgery in Europe (n = 13), the United States (n = 4) and Canada (n = 1). Of these patients, 4572 (88%) underwent complete surgical resection. The primary tumor was epithelial in 2260 cases, sarcoma in 2173, germ cell in 363, and melanoma in 328. The disease-free interval was 0 to 11 months in 2199 cases, 12 to 35 months in 1857, and more than 36 months in 1620. Single metastases accounted for 2383 cases and multiple lesions for 2726. Mean follow-up was 46 months. Analysis was performed by Kaplan-Meier estimates of survival, relative risks of death, and multivariate Cox model. Results: The actuarial survival after complete metastasectomy was 36% at 5 years, 26% at 10 years, and 22% at 15 years (median 35 months); the corresponding values for incomplete resection were 13% at 5 years and 7% at 10 years (median 15 months). Among complete resections, the 5-year survival was 33% for patients with a disease-free interval of 0 to 11 months and 45% for those with a disease-free interval of more than 36 months; 43% for single lesions and 27% for four or more lesions. Multivariate analysis showed a better prognosis for patients with germ cell tumors, disease-free intervals of 36 months or more, and single metastases. Conclusions: These results confirm that lung metastasectomy is a safe and potentially curative procedure. Resectability, disease-free interval, and number of metastases enabled us to design a simple system of classification valid for different tumor types.

Original languageEnglish
Pages (from-to)37-49
Number of pages13
JournalJournal of Thoracic and Cardiovascular Surgery
Volume113
Issue number1
DOIs
Publication statusPublished - 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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    Pastorino, U., Buyse, M., Friedel, G., Ginsberg, R. J., Girard, P., Goldstraw, P., Johnston, M., McCormack, P., Pass, H., Putnam J.B., J., Rusch, V. W., & Nazari, S. (1997). Long-term results of lung metastasectomy: Prognostic analyses based on 5206 cases. Journal of Thoracic and Cardiovascular Surgery, 113(1), 37-49. https://doi.org/10.1016/S0022-5223(97)70397-0