Surgical management of pulmonary metastases

Between 1969 and 1979 at the Toronto General Hospital, 78 patients were assessed for possible resection of pulmonary metastases, assuming that the primary tumour was controlled and no other known metastatic foci were present. Primary tumours were renal in 16 patients, colorectal in 15 and breast in 10; 11 had sarcoma, 5 melanoma and 21 had miscellaneous primary cancers. Metastases were resected in 64 patients. Thirteen patients did not undergo resection since additional information indicating inoperability was provided by whole lung tomography in 6, mediastinoscopy in 4 and thoracotomy in 3. One patient was considered medically to have inoperable disease. There was one death postoperatively and major complications were encountered in six patients. Follow-up was possible in 62 of the 64 patients who underwent resection. Actuarial survival at 2 and 5 years was 63% and 42% respectively. Of 12 patients who had a disease-free interval of less than 12 months, only 3 are alive (mean survival 37.6 months). Of 48 patients with a disease-free interval longer than 12 months, 24 are alive (mean survival 55.1 months). Six of 14 patients with primary tumour of the colorectum are alive a mean of 40 months (range from 6 to 80 months) after resection; the other 8 survived a mean of 22 months (range from 5 to 61 months). Of 14 patients with renal tumours, only 3 are alive; 11 patients died, having survived a mean of 22.5 months (range from 3 to 59 months). This review supports resection of pulmonary metastases in selected patients, particularly those with a disease-free interval of longer than 12 months.