Efficacy of pulmonary metastasectomy for recurrent soft tissue sarcoma

Abstract

To evaluate surgical results of resection of second (recurrent) pulmonary metastases from adult soft tissue sarcoma, the survival of 39 patients was analyzed retrospectively. With the exclusion of two patients (one with interval metastases between staged resections and one without histologically proved metastases), three patients were found to have unresectable disease (median survival, 7 months). A significantly (P = 0.0001) longer median survival (28 months) was found for 34 patients whose recurrent metastases were completely resected. The only other factor predicting significantly longer post-thoracotomy survival was resection of a solitary metastatic nodule (median survival, 65 months). Patients who had two or more recurrent nodules resected had a median survival of 14 months only (P = 0.01). Although trends toward longer survival were noted for other prognostic factors, none reached statistical significance. We conclude that the complete resection of a solitary second (recurrent) pulmonary metastatic nodule from adult soft tissue sarcoma predicts long-term survival.

Survival after pulmonary metastasectomy in soft tissue sarcoma: Prognostic factors in 214 patients

“…Another variable found to be independently significant was the number of metastases. This accords with the study by Casson et al (1991) who also found that 2 or more pulmonary metastases were associated with a significant decrease in median survival. A study from the National Cancer Institute has also shown that the number of pulmonary nodules affected survival (Roth et al 1985).…”

Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data

“…There was one retrospective cohort study of data obtained from a Cancer Centre's institutional Tumor Registry 11. In other reports, cases were identified from databases which were held, as far as we could determine, at an institutional level10 12–17 20 23 26 27 or departmental level 18 19 21 24 25. It appears that many of the clinical data were retrieved by retrospective case note review.…”

“…In 10 of the 18 reports, statistical analyses were performed to identify patient and tumour characteristics associated with improved survival following first pulmonary metastasectomy 11 13 14 16 18 19 21 23 25 26…”

“…One study with five subgroups gave group-by-group criteria which, read in context, appeared to be defined after exploration of the available data to facilitate analysis and reporting 23. Criteria for inclusion or exclusion in the metastasectomy cohort were not found in three studies 14 16 25…”

Multimodality therapy for metastatic sarcomas confined to the lung

“…Metastectomy has a long history in the management of multiple tumors from other sites that have spread to the lungs, particularly late recurrences from primary sarcomas extirpated from other parts of the body. The natural history of metastatic sarcomas in the lung is terminal (1)(2)(3). Colorectal adenocarcinomas, which are far more common than sarcomas, commonly spread to the lungs and are often resected and chemotherapy is administered neoadjuvantly or adjuvantly.…”