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

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.