Current Thoracic Surgery 2021 , Vol 6 , Issue 1
Which factors significantly reduce long-term survival after pulmonary metastasectomy?
Yunus Seyrek1,Levent Cansever2,Mehmet Ali Bedirhan2
1Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
2Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Disease and Thoracic Surgery Application and Research Center, Istanbul, Turkey
DOI : 10.26663/cts.2021.0003 Viewed : 1306 - Downloaded : 452 Background: In this study, a survival analysis was performed of patients who underwent pulmonary metastasectomy over the past 10 years in our clinic. We aimed to elucidate the factors that significantly affected overall survival and identify subgroups of patients who may not benefit from pulmonary metastasectomy.

Materials and Methods: We retrospectively reviewed 68 patients with a history of extra-thoracic malignancy who underwent pulmonary metastasectomy between January 2009 and December 2018. The overall survival rate was analyzed according to age, sex, histological type of the primary tumor, metastatic side, surgical approach type, pulmonary resection type, number of nodules resected, diseasefree interval, and nodal status.

Results: The actuarial survival rate after pulmonary metastasectomy was 78% (95% confidence interval [CI]: 71-84) at 2 years and 48% (95% CI: 41-52) at 5 years. Patients with disease free interval < 12 months had a far worse survival rate (p = 0.001). Patients with sarcoma had a significantly worse prognosis than those with epithelial tumors or melanoma (p = 0.001). Patients with negative nodal status had a significantly better prognosis (p = 0.001), while patients with metastatic hilar lymph nodes also had significantly better survival compared to patients with metastatic mediastinal lymph nodes (N2) (p = 0.001).

Conclusions: Tumor histology is the main determinant of overall survival and prognosis after pulmonary metastasectomy. The presence of multiple metastases in different unilateral lobes and N2 disease appeared to be the worst prognostic factors. Patients with either of these two significant negative prognostic factors should be evaluated carefully via a multidisciplinary approach and pulmonary metastasectomy should be performed only in selected patients. Keywords : metastasectomy, pulmonary, negative prognostic factors, long term survival