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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2001 December;42(6):835-40

language: English

Pulmonary metastatectomy for soft tissue sarcomas: is it valuable?

Belal A., Salah E. *, Hajjar W. *, El-Foudeh M., Memon M., Ezzat A., Al-Kattan K. *

From the Department of Oncology and Thoracic Surgery* King Faisal Specialist Hospital and Research Center Riyadh, Kingdom of Saudi Arabia


Background. A ret­ro­spec­tive ­study and anal­y­sis was per­formed to deter­mine the val­ue and ben­e­fit of pul­mo­nary met­a­sta­tec­to­my for ­soft tis­sue sar­co­mas, and ­which fac­tors pre­dict prog­no­sis fol­low­ing resec­tion.
Methods. Twenty-­three ­patients under­went resec­tions for pul­mo­nary metas­ta­ses ­from a ­soft tis­sue sar­co­ma (STS) at King Faisal Specialist Hospital and Research Center (KFSH&RC), ­between January 1985 and December 1998. There ­were 11 ­male and 12 ­female ­patients. Thirteen of 23 ­patients (57%) had one to three metas­ta­ses, and 10 (43%) had four or ­more metas­ta­ses. A ­total of 41 tho­rac­ic explo­ra­tions was per­formed for the 23 eval­u­able ­patients. Median ster­not­o­my was ­used ­only for three ­patients and lat­er­al thor­a­cot­o­my was ­used for 20 ­patients as an ­initial sur­gi­cal ­approach. Pulmonary resec­tions per­formed includ­ed one or ­more ­wedge resec­tions (n=16), seg­men­tec­to­my (n=5), and lobec­to­my (n=2). No one in ­this ­series under­went pneu­mo­nec­to­my. The num­ber of resect­ed met­a­stat­ic nod­ules ­ranged ­from one-six ­with aver­age three. Eight ­patients (35%) ­received var­i­ous ­kinds of post­op­er­a­tive adju­vant chem­o­ther­a­py.
Results. The over­all and dis­ease-­free sur­vi­val ­rate ­post-met­a­sta­tec­to­my at five ­years was 24% and 21%, respec­tive­ly. Various prog­nos­tic indi­ca­tors ­were exam­ined to eval­u­ate ­their asso­ci­a­tion ­with ­improved sur­vi­val. Age, sex local­iza­tion of the pri­mary ­site and his­to­log­ic ­type, ­tumor ­grade, ­size of the resect­ed nod­ules, lat­er­al­ity (uni­lat­er­al or bilat­er­al), ­types of resec­tion, adju­vant chem­o­ther­a­py, and ­local recur­rence did not sig­nif­i­cant­ly ­affect sur­vi­val. However, ­patient ­with dis­ease ­free inter­val >6 ­months, and ­those ­with ­three or few­er metas­ta­ses ­showed a ­trend ­toward a high­er five-­year over­all sur­vi­val (p=0.06, 0.07, respec­tive­ly).
Conclusions. Surgical exci­sion of ­lung metas­ta­ses ­from ­soft tis­sue sar­co­mas is ­well accept­ed and ­should be con­sid­ered as a ­first ­line of treat­ment if pre­op­er­a­tive eval­u­a­tion indi­cat­ed ­that com­plete resec­tion of the metas­ta­ses is pos­sible. Further inves­ti­ga­tion is need­ed ­before chem­o­ther­a­py can be rec­om­mend­ed as addi­tion­al ther­a­py.

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