Short-term and long-term outcomes of repeated surgeries for lung metastases

Background. There is still no consensus on the feasibility of repeated surgeries for lung metastases.
Aim. To compare the short-term and long-term outcomes of primary and repeated surgeries for lung metastases.
Materials and methods. This retrospective study included patients with lung metastases from colorectal cancer, germ cell tumors, renal cell carcinoma, osteogenic sarcomas, and soft tissue sarcomas operated on in N. N. Blokhin National Medical Research Center of Oncology between 1997 and 2017. Overall survival and the incidence of postoperative complications (Clavien–Dindo classification) were the main parameters evaluated.
Results. We identified 613 patients who had undergone resection of lung metastases; of them, 65 patients (10.6) had had repeated surgeries for lung metastases. R0 resection was the only prognostic factor for overall survival in patients with repeated surgeries for lung metastases (hazard ratio 7.691; 95 % confidence interval 3.163–18.702; р <0.001). Postoperative complications were observed in 48 patients after primary surgeries (7.8 %) and 11 patients after repeated surgeries (16.9 %) (р = 0.02). Five patients after primary surgeries (0.8 %) and 2 patients after secondary surgeries (3.1 %) died (р = 0.139). R0 resections were achieved in 576 (94 %) and 57 (87.7 %) patients after primary and secondary surgeries, respectively (р = 0.065). The five-year overall survival rate was 61.2 % after primary surgery and 53 % after repeated surgery (р = 0.91).
Conclusions. Repeated surgeries for resectable lung metastases ensure long-term outcomes comparable to those after primary operations. Repeated surgeries are associated with an increased risk of postoperative complications, but not postoperative mortality