Surgical treatment of lung metastases: Prognostic factors for long-term survival

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Abstract
Background and Objectives Surgical resection of lung metastases is an established therapy for a large number of primary tumors, but there is some controversy about prognostic factors for long-term survival. Methods From 1968 to 1996, we performed a retrospective review of a series of 85 patients (100 operations) that have been operated for resection of lung metastases. The Kaplan-Meier method was used to estimate the probabilities of survival, the log-rank test for the univariate analysis of prognostic factors for survival, and the Cox model in the subsequent multivariate analysis. Results The operative mortality was 4% and the morbidity 18%. The mean follow-up after lung resection was 22.13 months (1–146). The actuarial 5-year survival rate was 29.2%. By univariate analysis, the following factors were associated with survival after resection: location and histology of the primary tumor, greatest dimension of the largest metastasis, radicality of the resection, involvement of the resection margins, and use of adjuvant therapy (P < 0.05). After multivariate analysis, only the dimension of the metastases and involvement of surgical margins have been found to be independently associated with survival. Conclusions Surgical excision is a safe and effective therapy for lung metastases from a large number of primary tumors, provided a complete resection is feasible. J. Surg. Oncol. 1999;72:193–198.