Survival following pulmonary metastasectomy.

One hundred and fifty-six thoracic operations have been performed over an 8-year period, from 1980 to 1987, for 118 patients with pulmonary metastases. In 27 instances, the disease has been bilateral requiring a midline approach or sequential lateral thoracotomies. Resection was achieved by wedge excision in 74%, lobectomy in 16%, pneumonectomy in 4%, lobectomy plus wedge excision in 2%, bilobectomy in 1%, segmentectomy in 2% and segmentectomy plus wedge excision in 1%. The operative mortality for the group as a whole was 1.6% per patient (70% confidence limits CL. 0.6%-4.2%) and 1.2% per operation (70% CL. 0.5-3.2%). Actuarial survival for the histological subgroups at 2 and 5 years were: carcinoma 50% (+/- 11% standard error) and 35% (+/- 12%), sarcoma 59% (+/- 10%) and 51% (+/- 12%), teratoma 89% (+/- 5%) and 84% (+/- 7%) respectively. No patient following resection for metastatic melanoma was alive at 2 years. The survival in the teratoma group was significantly higher than in the other groups (P less than 0.001 carcinoma; P less than 0.01 sarcoma; P less than 0.001 melanoma). Survival in all groups was significantly greater than for the melanoma group. Metastasectomy is well tolerated by the patient. Worthwhile longterm survival is obtained in those patients in whom the primary disease has been controlled and all secondary disease is encompassed by the proposed surgery.