Objective: The aim of this retrospective study was to establish the prognosis in lung tumour cases in which resection was followed by synchronous or metachronous intrapulmonary metastasis.
Methods: Between 1990 and 1999, 857 patients were operated on for primary lung cancer. Intrapulmonary metastases were observed in 21 patients. 11 cases were in stage III/B (on the basis of T4), and 10 were in stage IV (on the basis of M1). The histologic distribution of the primary tumours was 7 squamous cell carcinomas, 11 adenocarcinomas, 2 large cell carcinomas and 1 carcinoid. In 8 patients, histology demonstrated N1 or N2 lymph node metastasis. In 4 cases, there were more than one metastases.
Results: The 5-year survival was 21%, and the mean survival time (MST) was 29.5 months. For both the 5-year survival rate and MST, there was significant difference between the lymph node negative (N0) and lymph node positive (N1/N2) patients (N-: 30.7%, N+: 0%, p=0.017, MST: N-: 38.3 months, N+: 10.5 months, p=0.014), according to the stage (III/B: 30%, IV: 11.1%, p=0.025, III/B: 40.1 months, IV: 17.8 months, p=0.04) and the number of metastases (1 metastasis: 26.6%, more than 1 metastasis: 0%, p=0.036, 1 metastasis: 35.2 months, more than 1 metastasis: 8.5 months, p=0.045). No significant difference was detected on the basis of histological type, pleural, vascular and lymphatic invasion. In patients where 1 metastasis was found within one lobe and there were no lymph node metastases, the 5-year survival rate was 42.8% and MST was 49 months. The complication rate was 28.5% and the 30-day mortality was 4.7% (1 patient). Reoperation was performed in 1 case, for thoracic wall haematoma.
Conclusion: Primary lung tumours giving intrapulmonary metastases, under certain conditions (lymph node negativity, 1 metastasis in the same lobe), can be operated on with good survival possibilities.