Selection factors resulting in improved survival after surgical resection of tumors metastatic to the lungs.

From 1973 through 1987, a total of 140 patients underwent 184 operations for removal of metastatic tumors to the lungs. The number of lesions removed ranged form one to 30. Of the patients, 44% had solitary lesions. Overall 3-year survival was 62.6%, and 5-year survival was 48.2%. In all primary tumors except melanoma and breast cancer, 3-year survival was greater than 50% and 5-year survival was greater than 40%. With rare exceptions, the operation of choice for unilateral lesions was ipsilateral thoracotomy, and for bilateral lesions it was median sternotomy. Adequate conservative resection was the rule. There were three pneumonectomies, 25 lobectomies, 71 single wedge resections, 38 multiple unilateral wedge resections, and 47 bilateral wedge resections. There were no postoperative hospital deaths. Cox covariate analysis demonstrated improved survival in patients whose largest lesion was less than 1.5 cm in diameter and with disease-free interval longer than 1 year, but survival was not related to number of lesions or age of patient. An aggressive surgical approach is justified in patients with most primary tumors and a limited number of lung metastases less than 1.5 cm in diameter. Resection of metastases from melanoma and breast cancer should be accomplished after other sites of metastatic disease have been ruled out by the most stringent criteria.