Residual masses after treatment: occur in 40% of cases with advanced disease and negative tumor markers
50% are necrotic tissue
25% are residual cancer (up to 50% are then cured by surgery)
25% are mature teratomas, that may grow (90% are then cured by surgery)
Pulmonary Metastasectomy: indicated for patients with control of primary disease and lack of other pulmonary or non-pulmonary mets (mortality <2%/ morbidity: 10%)
Prognostic Factors for Metastasectomy
Number of resected mets: no difference (but all mets must be resected/ >50 can be resected at a time)
Tumor aggressiveness: no association between disease-free interval (between diagnosis and occurrence of pulmonary mets) and survival (except in breast cancer), although tumor-doubling time <20 days has poorer outcome
Type of malignancy: better outcome with malignancies that metastasize almost solely to lungs (sarcoma)
Tumor chemo-responsiveness: no prognostic advantage/disadvantage
Five-Year Survival after Metastasectomy (uncontrolled trials)
Testicular/germ cell cancer: 50%
Breast cancer: 36-45%
Osteosarcoma: 25-50% (with resection of all lung mets)
Soft tissue sarcoma: 20-35%
Melanoma: 25%
Renal cell cancer: 60%
Colon/Rectal cancer: 45%
Complications
Persistent Air-Leak
Infection: increased incidence with recent chemo pre-op
ARDS: increased incidence with extensive use of chemo, XRT pre-op and high FiO2 post-op
