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Prolonged Survival After Extracranial Metastasectomy From Synchronous Resectable Lung Cancer

From the Department of Thoracic Surgery, Tor Vergata University, Rome, Italy.

Correspondence: Address for correspondence and reprints: Prof. Tommaso Claudio Mineo, Cattedra di Chirurgia Toracica, Ospedale S. Eugenio, p.le Umanesimo 10, 00144 Rome, Italy; Fax: 39-06-592-2681; E-mail: mineo{at}med.uniroma2.it

Background: Combined resection of solitary synchronous brain metastases and non–small-cell lung cancer has been shown to be successful. Thus, we proposed combining the surgery of solitary, extracranial metastases, and resectable lung cancer.

Methods: Between March 1987 and December 1994, surgery was performed on nine patients with non–small-cell lung cancer with synchronous, solitary, extracranial, or distant metastasis: adrenal (n = 5), cutaneous (n = 2), axillary lymph node (n = 1) and kidney (n = 1). Criteria for operating on these patients included: primary tumor that was locally resectable in a radical manner, non–small-cell histology, no preoperative evidence of N2 disease, complete resection of histologically proven metastasis, and absence of other metastases found with computed tomography or bone scan.

Results: Resection of the primary tumor and solitary metastases was achieved in all patients. Primary tumor was always resected by lobectomy. No mortality or major morbidity was reported. Five-year survival rate was 55.6%. Five patients who had adrenal (n = 3), or skin (n = 1), or axillary (n = 1) metastases, survived more than 5 years. All N2 patients (n = 2) died.

Conclusions: The presence of solitary, distant metastasis should not be considered, per se, a factor for denying surgery for locally resectable, non–small-cell lung cancer. Unexpected, prolonged survival was demonstrated in our limited series.

Key Words: Lung cancer • Adrenal metastasis • Skin metastasis • Surgery

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