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Thorac Cardiovasc Surg 2006; 54(7): 489-492
DOI: 10.1055/s-2006-924248
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Pulmonary Metastasectomy in Patients with Soft Tissue Sarcomas: Experiences in 50 Patients

J. Pfannschmidt1 , J. Klode1 , T. Muley1 , H. Dienemann1 , H. Hoffmann1
  • 1Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany
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Publication History

Received November 19, 2005

Publication Date:
06 November 2006 (online)

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Abstract

Background: Pulmonary resection of metastatic soft tissue sarcomas is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome and prognostic factors after surgery. Methods: Between 1996 and 2001, 50 patients (27 men, 23 women) with pulmonary metastases from a soft tissue sarcoma underwent surgical resection. Inclusion criteria for the study were the absence of primary tumor recurrence and other extrapulmonary metastases. Complete resection (CR) was achieved in 31 patients. Results: The overall 5-year survival rate was 37.6 %. The 5-year survival rate after complete metastasectomy was 52.7 %, but none of the patients who underwent incomplete resection survived 3 years. Complete resection was found to be a significant prognostic factor for survival following metastasectomy (p < 0.0001). Of the prognostic factors analyzed, age, sex, repeat thoracotomy, thoracic lymph node involvement, number of metastases, disease-free interval, histology and histological grading did not influence survival. Conclusion: We conclude that pulmonary resection of metastatic soft tissue sarcomas is a safe and effective treatment, which offers an improved survival benefit. Prognosis-related criteria are identified which support the necessity of complete surgical resection of all clinically detected metastases.

Key words

Pulmonary metastases - soft tissue sarcoma - prognostic factors - surgery

References

  • 1 American Cancer Society I .Cancer Facts and Figures 2003. 2003 http://www.cancer.org
    Google Scholar
  • 2 Weiss (ed) S W. World Health Organization. International Typing of Soft Tissue Tumours, 2nd ed. Berlin, Heidelberg, New York; Springer 1994: 3
    Google Scholar
  • 3 Gortzak E, Azzarelli A, Buesa J. et al . A randomized phase II study on neo-adjuvant chemotherapy for ‘high-risk’ adult soft-tissue sarcoma.  Eur J Cancer. 2001;  37 1096-1103
    CrossrefPubMedGoogle Scholar
  • 4 Dienemann H, Hoffmann H, Koebe H G. Technique and rationale of lymph node dissection in bronchial carcinoma.  Chirurg. 1998;  69 412-417
    CrossrefPubMedGoogle Scholar
  • 5 Greene F L, Balch C M, Fleming I D, April (eds) F. AJCC Cancer Staging Manual. 6th edition. New York; Springer 2002: 193-197
    Google Scholar
  • 6 Abel U, Berger J, Wiebelt H. Critlevel: an exploratory procedure for the evaluation of quantitative prognostic factors.  Methods Inf Med. 1984;  23 154-156
    PubMedGoogle Scholar
  • 7 Kaplan E, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
    CrossrefPubMedGoogle Scholar
  • 8 Peto R, Peto J. Asymptomatically efficient rank invariant test procedures.  J R Stat Soc A. 1972;  135 185-206
    PubMedGoogle Scholar
  • 9 Schirren J, Krysa S, Bulzebruck H. et al . Results of surgical treatment of pulmonary metastases from soft tissue sarcomas.  Recent Results Cancer Res. 1995;  138 123-138
    PubMedGoogle Scholar
  • 10 Kimura H, Suzuki M, Ando S. et al . Pulmonary metastasectomy for osteosarcomas and soft tissue sarcomas.  Gan To Kagaku Ryoho. 2004;  31 1319-1323
    PubMedGoogle Scholar
  • 11 Ueda T, Uchida A, Kodama K. et al . Aggressive pulmonary metastasectomy for soft tissue sarcomas.  Cancer. 1993;  72 1919-1925
    CrossrefPubMedGoogle Scholar
  • 12 Jablons D, Steinberg S M, Roth J, Pittaluga S, Rosenberg S A, Pass H I. Metastasectomy for soft tissue sarcoma. Further evidence for efficacy and prognostic indicators.  J Thorac Cardiovasc Surg. 1989;  97 695-705
    PubMedGoogle Scholar
  • 13 Kick J, Schelzig H, Heinecke A, Forster R. Resection of lung metastases - risk or chance?.  Zentralbl Chir. 2005;  130 534-538
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Van Geel A N, van Coevorden F, Blankensteijn J D. et al . Surgical treatment of pulmonary metastases from soft tissue sarcomas: a retrospective study in The Netherlands.  J Surg Oncol. 1994;  56 172-177
    PubMedGoogle Scholar
  • 15 Billingsley K G, Burt M E, Jara E. et al . Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival.  Ann Surg. 1999;  229 602-610 610-612
    CrossrefPubMedGoogle Scholar
  • 16 Verazin G T, Warneke J A, Driscoll D L, Karakousis C, Petrelli N J, Takita H. Resection of lung metastases from soft-tissue sarcomas. A multivariate analysis.  Arch Surg. 1992;  127 1407-1411
    CrossrefPubMedGoogle Scholar
  • 17 Van Geel A N, Pastorino U, Jauch K W. et al . Surgical treatment of lung metastases: the European Organization for Research and Treatment of Cancer, Soft Tissue and Bone Sarcoma Group study of 255 patients.  Cancer. 1996;  77 675-682
    CrossrefPubMedGoogle Scholar
  • 18 Casson A G, Putnam J B, Natarajan G. et al . Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma.  Cancer. 1992;  69 662-668
    CrossrefPubMedGoogle Scholar
  • 19 Younes R N, Gross J L, Deheinzelin D. Surgical resection of unilateral lung metastases: is bilateral thoracotomy necessary?.  World J Surg. 2002;  26 1112-1116
    CrossrefPubMedGoogle Scholar
  • 20 Kamiyoshihara M, Hirai T, Kawashima O, Ishikawa S, Morishita Y. The surgical treatment of metastatic tumors in the lung: is lobectomy with mediastinal lymph node dissection suitable treatment?.  Oncol Rep. 1998;  5 453-457
    PubMedGoogle Scholar
  • 21 Pfannschmidt J, Muley T, Hoffmann H, Dienemann H. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients.  J Thorac Cardiovasc Surg. 2003;  126 732-739
    CrossrefPubMedGoogle Scholar
  • 22 Pfannschmidt J, Hoffmann H, Muley T, Krysa S, Trainer C, Dienemann H. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma.  Ann Thorac Surg. 2002;  74 1653-1657
    CrossrefPubMedGoogle Scholar
  • 23 Casper E S, Gaynor J J, Harrison L B, Panicek D M, Hajdu S I, Brennan M F. Preoperative and postoperative adjuvant combination chemotherapy for adults with high-grade soft tissue sarcoma.  Cancer. 1994;  73 1644-1651
    PubMedGoogle Scholar
  • 24 Choong P F, Pritchard D J, Rock M G, Sim F H, Frassica F J. Survival after pulmonary metastasectomy in soft tissue sarcoma. Prognostic factors in 214 patients.  Acta Orthop Scand. 1995;  66 561-568
    CrossrefPubMedGoogle Scholar
  • 25 Robert J H, Ambrogi V, Mermillod B, Dahabreh D, Goldstraw P. Factors influencing long-term survival after lung metastasectomy.  Ann Thorac Surg. 1997;  63 777-784
    CrossrefPubMedGoogle Scholar
  • 26 Gadd M A, Casper E S, Woodruff J M, McCormack P M, Brennan M F. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma.  Ann Surg. 1993;  218 705-712
    CrossrefPubMedGoogle Scholar
  • 27 Pastorino U, Valente M, Santoro A. et al . Results of salvage surgery for metastatic sarcomas.  Ann Oncol. 1990;  1 269-273
    PubMedGoogle Scholar

MD J. Pfannschmidt

Department of Thoracic Surgery
Thoraxklinik Heidelberg

Amalienstraße 5

69126 Heidelberg

Germany

Phone: + 49 6 22 13 96 11 01

Fax: + 49 6 22 13 96 11 02

Email: joachim.pfannschmidt@thoraxklinik-heidelberg.de