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Benefit of Surgical Treatment of Lung Metastasis in Soft Tissue Sarcoma
Alexander Rehders, MD;
Stefan B. Hosch, MD;
Peter Scheunemann, MD;
Nikolas H. Stoecklein, MD;
Wolfram T. Knoefel, MD;
Matthias Peiper, MD
Arch Surg. 2007;142(1):70-75.
Hypothesis Patients with pulmonary metastatic soft tissue sarcoma benefit from resection, with long-term cure possible.
Design Retrospective medical records review.
Setting Academic tertiary care center.
Patients Between January 1, 1991, and December 31, 2002, 61 patients (33 men and 28 women; median age at initial diagnosis, 42 years [age range, 18-74 years]) were surgically treated for pulmonary metastases of soft tissue sarcoma at University Hospital, Hamburg-Eppendorf, Germany.
Interventions Sternotomy or anterior lateral thoracotomy was performed for metastasectomy, including wedge resection or lobectomy.
Main Outcome Measure The effects of clinical and pathologic factors on disease-specific survival were analyzed using the log rank test and a multivariate Cox proportional hazards model.
Results Primary tumor size was pT1 in 13 patients and pT2 in 48 patients. The differentiation was high in 7 patients, intermediate in 19 patients, and low in 35 patients. The mean number of resected pulmonary metastatic lesions was 5 (range, 1-48). An anterolateral thoracotomy was performed in 39 patients, and sternotomy in 22 patients. There were no significant postoperative complications that required surgical revision. The perioperative mortality was 0%. At a mean follow-up of 60 months, the mean survival time after metastasectomy was 33 months (range, 2-125 months). The 5-year survival was 25%. The number of resected lung metastatic lesions had no prognostic relevance (P = .37).
Conclusions Patients with lung metastasis from soft tissue sarcomas benefit from surgical excision. This treatment has low complication rates and has a favorable influence on the course of the disease. Long-term survival is possible even when recurrent pulmonary disease is resected.
Author Affiliations: Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Düsseldorf (Drs Rehders, Hosch, Scheunemann, Stoecklein, Knoefel, and Peiper); Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf (Drs Rehders, Hosch, Scheunemann, Stoecklein, Knoefel, and Peiper), Germany.
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