Prognostic analysis of Pulmonary Metastasectomy.

The first, and perhaps most famous, planned pulmonary metastasectomy in the United States was performed in 1933 by Barney and Churchill for metastatic renal cell carcinoma. During the nineteenth century there were sporadic reports of lung resections for metastatic tumors reported in the European literature. The first one of these reports was in 1855, by the French surgeon Sedillot, who removed a chest wall tumor and excised disease extending into the lung. Almost 30 years later, in 1882, Weinlechner was credited for the first resection of a true pulmonary metastases.It was not for another 40 years that metastasectomy was performed as a separate procedure by Divis in Europe. This was followed soon after by similar reports in the American literature by Torek and Tudor Edwards in the early twentieth century. These early reports, and others like them, paved the way toward general acceptance of pulmonary metastasectomy. In 1947 Alexander and Haight reported the first series of pulmonary metastasectomies. By the 1950s there were numerous case series with similar accounts. Today the indications for resection of secondary pulmonary malignancies have been broadened to include patients not only with recurrent disease, but those with multiple metastases, bilateral lesions, and essentially all histologies. AIMS AND OBJECTIVES : 1. To assess the long term results of pulmonary metastasectomy. 2. To assess prognostic factors which are likely to influence long term outcomes. 3. To find out a favourable subset of prognostic group who may benefit from pulmonary metastasectomy METHOD : Between January 1997 to December 2006 , all patients who underwent pulmonary metastasectomy were included in this analysis. Individual patient data were obtained from the case records in the MMTR which also serves as a HBTR for Cancer Institute (WIA). A total of 53 patient records were obtained , of that only 42 cases were taken analysis. Patients who underwent planned sequential or staged metastasectomies were considered to have single metastasectomy and redo surgery. Analysis was done using SPSS 11.0.1 statistical package. Following variables were tested : DFI ,unilateral or bilateral presentation, number of metastases, histological type and site of primary tumor, margin status, size of metastases, mediastinal nodes. Survival was calculated from the time of first metastasectomy to the last date of follow up by means of Kaplan – Meier estimate. CONCLUSION : Pulmonary metastasectomy is a potentially curative treatment that can be done safely with low mortality or morbidity. Good prognostic variables like increasing DFI (> 1 year), ability to do R0 resection, solitary metastasis, size of the lesion less than 1 cm, and absence of mediastinal nodal positivity showed a trend towards improved survival. Good prognostic group selected on the basis of the risk factors like completely resected lesions, DFI and number of metastases show a difference in survival between good risk and poor risk groups ( 88% and 65% at 36 months). Although these were not found to be significant in univariate or multivariate analysis using Cox regression analysis. There is a need for larger multicenteric analysis of data with larger duration of follow up, from specialized centres who practice pulmonary metastasectomy, to arrive at definite conclusions.