The effect of metastazektomy on survival ın secondary pulmonary neoplasms

Although metastatic tumors of lung are involved in systemic metastases of primary malignant tumors; they must be individually evaluated due to their specific properties. Treatment options in this condition are chemotherapy, radiotherapy, chemotherapy+radiotherapy combinations, hormone treatment and surgical excision of metastases. It is well known that pulmonary metastasectomies have beneficial effects on survival. In our study, place of metastasectomy in pulmonary neoplasms and its effect on survival were evaluated. A total of 29 case who underwent operation due to secondary pulmonary neoplasm in Karadeniz Technical University Faculty of Medicine, Department of Thoracic Surgery between 2010 and 2015 was enrolled in the study. Cases were evaluated in terms of age, gender, histopathological type of primary tumor, stage of secondary tumor and its preoperative radiological signs, length of life without illness, types of surgical incisions and type of resection, number of complete-incomplete resections, number of pre/postoperative nodules, cardiopulmonary evaluations and length of survival. 20 (69%) and 9 (31%) of cases were male and female; respectively. Youngest case was 18 years old whereas oldest case was 75 years old. Mean age of cases was 56. A total of 38 surgical intervention was performed on all cases. Most common surgical intervention was posterolateral thoracotomy in 24 cases. Second most common surgical procedure was video-assisted thorax surgery (VATS) in 14 cases. 1-year, 3-year and 5-year survival of cases undergone pulmonary metastasectomy were 96%, 72% and 58%; respectively. There was no mortality in Stage I and 5-year survival rate was 100% in this group. 3 of 12 Stage II patients died during follow-ups and 5-year survival rate was 75% in this group. 7 of Stage III patients died during follow-ups and 5-year survival rate was 50% in this group. In terms of histopathologic type of primary tumor, carcinoma (79,3%) and sarcoma (17,2%) were most common tumors. 5-year survival rates with metastasectomy were 40% and 73.5% in sarcomas and carcinomas; respectively. It was observed that pulmonary metastasectomy was more beneficial in carcinomas than sarcomas. In conclusion, metastasectomy significantly improves survival in secondary pulmonary neoplasm cases whose primary malignancy is under control without metastases in any other extrapulmonary area. In this study, it was observed that actual factors determining survival are stage of secondary tumor and histopathological type of primary tumor. KEY WORDS: Secondary pulmonary neoplasm, metastasectomy, survival