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The Annals of Thoracic Surgery, Vol 38, 323-330, Copyright © 1984 by The Society of Thoracic Surgeons
CF Mountain, MJ McMurtrey and KE Hermes
During a recent 20-year period, 556 patients underwent operation for
pulmonary metastasis at the University of Texas M.D. Anderson Hospital and
Tumor Institute at Houston. The surgical mortality was 1.5% for 772
resections. A selection of 443 patients was made to evaluate the
contribution of operative intervention as a primary treatment, with
selective adjunctive therapy when applicable. The success of a surgical
approach is dependent primarily on adherence to selection criteria; it is
important that only patients in whom all known disease can be completely
removed with the planned resection and who have full control of the primary
site are treated. The overall survival for the group was 35%. For patients
with carcinoma, survival ranged from 24% for those with primary uterine
cervix tumors to approximately 54% for urinary tract, male genital tract,
and corpus of uterus primary tumors. In the group with sarcoma, patients
with skeletal tumors had a 46.4% survival rate (50.7% for those with
osteogenic sarcoma), and 33% of the patients with soft tissue tumors had
long-term survival. The outcome for patients with melanoma was poor; only
12.1% survived 5 years. If the original criteria apply, multiple and
bilateral lesions can be successfully managed. Patients undergoing planned
adjuvant treatment had a superior outcome compared with those not so
treated. However, a significant survival advantage was shown only for
patients with sarcoma. The failure to control all disease in patients in
whom pulmonary metastasis is controlled surgically can only be improved on
through the use of systemically active adjuvant treatment.
ARTICLES
Surgery for pulmonary metastasis: a 20-year experience
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