Surgery for Pulmonary Metastases in Patients with Advanced Soft Tissue and Osteosarcomas

Background Advanced soft tissue or osteosarcoma is often associated with lung metastases. Curative pulmonary metastasectomy is appropriate for patients with successfully resected primary cancer who show no evidence of extrapulmonary metastases, with proven functional operability and completely resectable metastases. Material and Methods Systematic literature research and qualitative analysis of studies on patients undergoing lung metastasectomy after resection of primary sarcoma published since 01.01.2010. We assessed operative findings, survival data and prognostic factors. Results Pulmonary metastasectomy results in a median postmetastasectomy survival of 8.76 to 69.9 months. Five year survival rates after metastasectomy vary between 21.7 and 56.8%. The patients' prognosis depends particularly on complete resection of all suspected metastases. Intrapulmonary recurrence could be treated by repeated resection, but this procedure requires careful decision for indication. Re-metastasectomy might result in a favourable outcome in selected cases. Conclusion Pulmonary metastasectomy should be considered as treatment of choice in selected patients with isolated lung metastases from osteosarcoma. Optimal indication might lead to an advantage in patients with metastasectomy of isolated lung metastases from soft tissue.