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Ann Thorac Surg 2009;88:877-885. doi:10.1016/j.athoracsur.2009.04.144
© 2009 The Society of Thoracic Surgeons
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Shanda H. Blackmon
Jack A. Roth
Ara A. Vaporciyan
David C. Rice
Wayne Hofstetter
Garrett L. Walsh
Robert Benjamin
Stephen G. Swisher
Reza Mehran
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Original Articles: General Thoracic

Resection of Pulmonary and Extrapulmonary Sarcomatous Metastases Is Associated With Long-Term Survival

Shanda H. Blackmon, MD, MPHa,b,*, Nipam Shah, MDa,b, Jack A. Roth, MDa, Arlene M. Correa, PhDa, Ara A. Vaporciyan, MDa, David C. Rice, MB, BCha, Wayne Hofstetter, MDa, Garrett L. Walsh, MDa, Robert Benjamin, MDa, Raphael Pollock, MD, PhDa, Stephen G. Swisher, MDa, Reza Mehran, MDa

a University of Texas M. D. Anderson Cancer Center, Houston, Texas
b The Methodist Hospital, Houston, Texas

Accepted for publication April 29, 2009.

* Address correspondence to Dr Blackmon, Thoracic Surgery, The Methodist Hospital, 6550 Fannin St, Smith Tower, Suite 1661, Houston, TX 77030 (Email: shblackmon{at}tmhs.org).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: The presence of extrapulmonary sarcomatous metastases has traditionally been a contraindication for the resection of pulmonary metastases. We, therefore, reviewed our experience with resection of pulmonary metastases in patients who had documented extrapulmonary metastases to determine long-term outcome.

Methods: From 1998 to 2006, 234 patients underwent pulmonary metastasectomy. They were grouped as follows: group A (lung metastasectomy only); group B1 (with either synchronous or prior extrapulmonary metastasectomy); group B2 (with nonsurgical treatment of synchronous or prior extrapulmonary metastases); group C1 (with later extrapulmonary metastasectomy); group C2 (with later extrapulmonary metastasis which was not resected).

Results: Groups A, B1, and B2 consisted of 147 (62.8%), 26 (11.1%), and 13 (5.6%) patients, respectively. The median survival from lung metastasectomy date was 35.5, 37.8, and 13.5 months in groups A, B1, and B2, respectively. Comparison among the three groups showed no significant survival difference in groups A versus B1 (p = 0.96), but a survival difference was found comparing groups A versus B2 (p < 0.001) and B1 versus B2 (p < 0.001). Prognostic factors for increased survival included 3 or greater redo pulmonary operations, greater than 12 month mean time between pulmonary recurrences, greater than 24 month mean time between extrathoracic recurrences, and a prolonged disease-free interval. Prognostic factors for decreased survival included 3 or greater pulmonary metastases and group B2 patients.

Conclusions: These results suggest extrapulmonary metastases should no longer be viewed as a contraindication to resection of sarcomatous pulmonary metastases. Long-term survival can be achieved when a complete resection is possible for both the pulmonary and extrapulmonary metastases.






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