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J Thorac Cardiovasc Surg. 2014 Apr;147(4):1193-200; discussion 1200-1. doi: 10.1016/j.jtcvs.2013.12.021. Epub 2014 Jan 2.

Aggressive and minimally invasive surgery for pulmonary metastasis of sarcoma.

Author information

1
Division of Thoracic Surgery, University of California, San Francisco, Calif.
2
Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif.
3
Department of Pathology, University of California, San Francisco, Calif.
4
Division of Hematology & Oncology, University of California, San Francisco, Calif.
5
Division of Thoracic Surgery, University of California, San Francisco, Calif. Electronic address: Michael.Mann@ucsfmedctr.org.

Abstract

BACKGROUND:

Pulmonary metastasectomy has become a standard approach for sarcoma, but uncertainty remains regarding risk factors that accurately assess postoperative prognosis and can be used to guide surgical decision making.

METHODS:

We identified 145 patients who underwent 204 consecutive pulmonary metastasectomies for sarcoma between 1996 and 2009, and examined 174 complete resections in 118 patients. Predictors included surgical procedure, number/size of lesions, repeat resection, intervals to metastasis and to recurrence, chemotherapy, sarcoma subtype, distribution of pulmonary and extrapulmonary metastasis, and patient age/sex. Survival estimates were based on Kaplan-Meier analysis and compared using a log-rank test. Predictors were compared using univariate and multivariate Cox proportional hazards modeling.

RESULTS:

Among patients undergoing R0 resections, median survival was 35 months (95% confidence interval, 22-60 months), with 3-, 5- and 10-year survival of 48%, 42%, and 31%, respectively. The number or size of lesions did not influence survival. Metastasis synchronous to the primary tumor, but not disease-free interval, was a significant predictor of worse survival on single variable and adjusted modeling (hazard ratio, 3.0; 95% confidence interval, 1.4-6.6; P = .005); the presence of extrapulmonary metastasis and a need for anatomic resection were also likely predictors (P = .06 and P = .07). Recurrence of pulmonary metastasis was not associated with a reduction in survival if completely resected, and a more aggressive and less invasive surgical approach during the later half of the study period was not associated with a significant decline in survival.

CONCLUSIONS:

Evolving surgical practice may allow an increasingly aggressive approach to pulmonary sarcoma metastasis, which may be facilitated by increased use of a minimally invasive approach.

PMID:
24507991
DOI:
10.1016/j.jtcvs.2013.12.021
[Indexed for MEDLINE]
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