La terapia chirurgica delle metastasi polmonari. Analisi di 357 casi operati

Background. The study consists of a retrospective evaluation on survival in metastatic lung sarcomas and carcinomas, on surgical excisions of metastasis and on the determination of clinico-therapeutic parameters with prognostic significance. Methods. Eligibility criteria: oncologically adequate treatment of the primary lesion, no other metastasis except for lungs, possibility of an adequate surgical resection the lung metastasis. 357 patients (269 with metastasis from bone sarcomas, 57 from soft tissue sarcomas and 31 from carcinomas) were included in the study. The average time to lung relapse was 24 months for bone sarcomas, 23 for soft tissue sarcomas, and 32 for carcinomas. Lung metastasis were monolateral in 248 (69.5%) cases and bilateral in 109 (30.5%). 159 (44.5%) patients had single lung nodules, 105 (29.4%) 23 nodules, 49 (13.7%) 4-5 nodules, 44 (12.4%) more than 5 nodules. 225 patients (63%) underwent an atypical monolateral excision, 100 (28%) an atypical bilateral excision, 17 (5%) a lobectomy, 14 (4%) a lobectomy associated to an atypical excision, and 1 a pneumonectomy. Results. At an average observation of 35 months, 5-year overall survival was 40%. Prognosis was depending on: histotype (it was better in carcinoma than in sarcoma), number of nodules (it was better when there was a single lung nodule) and average time to relapse (patients with a disease free interval of more than 12 months had a better prognosis). Conclusions. Lung surgery for pulmonary metastasis is a valid approach in the therapeutic planning of patients with a secondary lung localization.