Pulmonary metastasectomy: a 14-year single-center experience and literature review

BACKGROUND: Pulmonary metastasectomy (PM) is a commonly performed surgical procedure in selected patients with metastatic disease. The characteristics of patients undergoing PM and the spectrum of primary malignancies considered for surgical resection vary across institutions. We aim to provide a better understanding of current practice patterns by describing the characteristics and perioperative outcomes of patients who underwent PM at our institution. METHODS: We conducted a retrospective descriptive study of patients who underwent pulmonary metastasectomy between 2008 and 2022 at Ghaem Hospital, Mashhad, Iran. Demographic and clinicopathological data, including age, sex, primary tumor type, histology, and postoperative outcomes, were collected and analyzed. RESULTS: A total of 128 patients (mean age, 38.9 ± 18.0 years) were included in the analysis. The most common primary tumor sites were bone (25.8%) and soft tissue (16.4%), followed by head and neck (9.4%), colorectal (7.0%), and testicular (7.0%) malignancies. Sarcoma was the predominant histologic subtype (57.8%), followed by squamous cell carcinoma (11.7%), adenocarcinoma (10.9%), and germ cell tumors (7.8%). Postoperative complications included air leakage (n = 35), vascular injury requiring blood transfusion (n = 34), and one surgical site infection. CONCLUSION: Pulmonary metastasectomy is performed in patients with a wide range of primary malignancies, with sarcoma representing the most common indication in our cohort. Review of the literature suggests that the role of pulmonary metastasectomy varies across different primary malignancies and depends on careful patient selection. Further prospective studies are needed to better define the clinical utility of pulmonary metastasectomy in different tumor types.