Long-Term Outcome of Patients Following Surgery for Metachronous Pulmonary Metastases of Highly Aggressive Non-Colorectal Cancers

Background: Most epithelial tumors metastasize to the lung. In 20% of cases no involvement of other organs can be detected. In patients with resectable colorectal lung metastases, the benefit of metastasectomy has been proven. No uniform guidelines exist, regarding entities such as hepatocellular carcinoma, pancreatic carcinoma or esophageal carcinoma. This study evaluated the long-term-outcome after resection of pulmonary metastases from highly aggressive, non-colorectal cancer entities. Methods: 49 patients were included who underwent complete pulmonary resection for lung metastases at the University Medical Center Hamburg-Eppendorf from 2000 to 2009. Overallsurvival rates were evaluated by Kaplan-Meier analysis. Results: The median follow-up time was 96 months. The overall median survival after diagnosis of the primary tumor was 59.9 months (mean survival 86.3 months). The overall 3-, 5and 10 year survival rate was 71.4% (35/49), 49% (24/49) and 26.5% (13/49). Median survival after metastasectomy was 22.6 months (mean 55 months). The 1-, 5and 10year survival rate after resection was 67.3% (33/49), 36.7 % (18/49) and 14.3% (7/49). The disease-free survival was 63.3% (31/49), 34.7% (17/49) and 12.2% (6/49) after 1, 3 and 5 years, respectively. Conclusions: Even in patients with highly aggressive, non-colorectal cancer, pulmonary metastasectomy can be performed with a low morbidity and mortality. It can improve overall survival and provide a chance of long oncological outcome in selected patients. However, the decision to perform a pulmonary metastasectomy in this setting requires a multidisciplinary setting.