Median sternotomy and multiple lung resections for metastatic sarcomas

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Abstract
In the attempt to apply salvage surgery to the majority of patients withpulmonary tumour relapse, we have adopted a new treatment plan consistingof early bilateral lung exploration and resection through median sternotomyin all cases of sarcoma with resectable lung metastases, includingsynchronous or previously resected ones. The present paper summarizes theearly results achieved with this technique in 56 consecutive patientstreated between 1985 and 1988. Perioperative mortality was zero, andmorbidity negligible. Occult contralateral metastases were resected inabout one third of subjects with monolateral clinical lesions. Overallactuarial survival from first pulmonary resection is 51% at 2 years and 35%at 3 years. A slightly more favourable trend is evident for solitarylesions but the difference is not statistically significant. No differencein survival is observed in relation to the initial disease-free interval orto the histological type. The majority of relapses occurred within 6 monthsof sternotomy (23/35) and were confined to the lungs (21/35). Ten of these21 patients with pulmonary relapse have undergone further resection and 5of them are alive, with a median survival of 28 months. Present results areencouraging as far as resectability and early recurrence rate areconcerned. Median sternotomy appears a most valuable therapeutic approachto pulmonary metastases from sarcomas, being safe and effective in localcontrol of disease, and compatible with further surgical management ofpulmonary recurrences.

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