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Eur J Cardiothorac Surg 2002;22:335-344
© 2002 Elsevier Science NL
a Department of Thoracic Surgery, Klink Schillerhoehe, Solitudestrasse 18, D-70839 Gerlingen, Germany
b Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
c Department of Thoracic Surgery, Toronto General Hospital, Toronto, Canada
d Department of Thoracic Surgery, The Royal Brompton Hospital, England, UK
e Department of Surgery and Oncology, Wayne State University, Harper Hospital, Detroit, USA
f Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Received 15 October 2001; received in revised form 3 April 2002; accepted 18 April 2002.
* Corresponding author. Tel.: +49-7156-203-2241; fax: +49-7156-203-2003
e-mail: friedel{at}klinik-schillerhoehe.de
Objective: Metastatic breast cancer is still defined as an incurable disease. Although the prognosis after resection of isolated metastases to the lung is much better than after chemotherapy most oncologists and gynecologists disapprove of lung metastasectomy. Methods: In order to summarize the experience of pulmonary metastatic surgery and to achieve more relevant data by an increased number of cases, we evaluate the data of the International Registry of Lung Metastases of 467 patients having lung metastases from breast cancer with regard to long-term survival and prognostic factors. Results: In 84% a complete metastatic resection was possible. The survival rates are 38% after 5 years, 22% after 10 years, and 20% after 15 years. Prognostic factors are a disease-free interval of 
36 months with 5-year survival of 45%, a 10-year survival of 26% and a 15-year survival of 21% (P=0.0001), solitary lung metastasis is associated with a survival rate of 44% after 5 years and of 23% after 10 and 15 years, but this is not statistically significant compared to multiple metastases. When establishing prognostic groups as suggested by Pastorino and the International Registry of Lung Metastases based on the risk factors disease-free interval, number of metastases and complete resection the group with the best prognosis showed 5-year survival of 50%, 10- and 15-year survival of 26% with a median survival of 59 months. Conclusion: Considering the low morbidity and mortality rate, we think that lung metastasectomy today is the best treatment option in selected cases of lung metastases from breast cancer.
Key Words: Breast cancer • Lung metastases • Lung metastasectomy • Prognostic factors
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