Pulmonary Metastasectomy – Analysis of Survival and Prognostic Factors in 243 Patients

BACKGROUND Pulmonary metastases are a sign of advanced malignant disease. Interdisciplinary management of metastatic cancer mandates the consideration of all treatment options, and in selected patients pulmonary metastasectomy can be performed with curative intent. This study aims to analyze the prognostic factors associated with survival and optimize the selection of surgical candidates. The sarcoma subset analysis aims to examine the role of multiple repeat resections for pulmonary metastatic recurrence. METHODS A total of 243 patients were analyzed in this retrospective cohort study. Overall survival was estimated using Kaplan-Meier analysis. Univariate analyses with log-rank tests and multivariate analysis with Cox proportional hazards model were undertaken to determine the independent prognostic factors for survival. RESULTS Multivariate analyses identified germ cell cancer (P = 0.01) and a disease-free interval of >36 months (P = 0.006) as significant independent prognostic factors for improved survival, whilst synchronous metastases (P = 0.04), multiple metastases (P = 0.005) and incomplete resection (P < 0.001) were identified as significantly poor prognostic factors. Subset analyses identified that ≥2 repeat resections within the sarcoma cohort was associated with an increased median survival of 63.5 months (P = 0.04). CONCLUSION In selected patients, pulmonary metastasectomy can be performed with curative intent and have associated long-term survival benefits. Patients presenting with recurrent sarcoma pulmonary metastases should be considered for repeat metastasectomy.