ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Assessment of metastasectomy and prognostic factors in the treatment of metastatic lung tumors
Ayşen Taslak Şengül, Ahmet Başoğlu, Yasemin Bilgin Büyükkarabacak, Tülin Durgun Yetim, Tamer Kutlu
Ondokuz Mayıs Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalı, Samsun
Background: The aim of the study was to evaluate the prognostic factors influencing survival following pulmonary metastasectomy and the importance of thoracic computed tomography (TCT) in detecting pulmonary metastases.

Methods: The study included 25 patients (16 males, 9 females; mean age 46.4 years) who underwent metastasectomy for secondary lung tumors and 10 control patients (6 males, 4 females; mean age 56.5 years) who were not eligible for surgery. Primary tumors included carcinoma in 17 patients (48.6%), sarcoma in 17 patients, and malignant melanoma in one patient (2.9%). Staging was made according to the system of the International Registry of Lung Metastases. A total of 31 operations were performed (24 wedge resections, 5 lobectomies, 1 enucleation, 1 debulking surgery). The two groups were compared with respect to survival and prognostic factors for metastasectomy patients were assessed.

Results: Operative mortality was seen in one patient (3.2%). The mean number of nodules detected by preoperative TCT was 2.7±2.4, compared to 7.6±10.5 nodules found at surgery (p=0.04). The accuracy of TCT in detecting nodules was 54.8%. One-year survival rate was 68% in metastasectomy patients, and 70% in the control group (p=0.707). The corresponding survival rates for three years were 44% and 0% (p=0.171). Patients with a single metastatic nodule exhibited significantly higher survival rates than patients having multiple nodules (for 1 year: 91.9% vs. 83.3%, p=0.023; for 3 years: 46.2% vs. 7.7%, p<0.001). The mean survival was significantly shorter in patients with stage III disease (p=0.002). One-year survival rates for stages I to III were 100%, 81.8%, and 50%, and three-year survival rates were 100%, 72.7%, and %8.3, respectively. Survival was not influenced by the following: cell type, disease-free interval, nodule diameter, number of resections, type of surgery, and postoperative chemotherapy.

Conclusion: Pulmonary metastasectomy improves survival in patients with a locally controlled primary tumor and no other metastases. As the stage increases, survival decreases. We believe that the staging system should be used widely in the prediction of survival.

Keywords : Lung metastasis, metastasectomy, survival, prognostic factors, computerized tomography
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