
<b>Metastasectomies, the surgical removal of metastases,</b> and/or the surgical removal of local recurrence, prolong survival time.   The complete removal of all known tumor, rendering a patient NED [No Evidence of Disease], is also called a surgical remission.  
So, if you have a local recurrence or a metastasis, it would be best to have it or them removed, if possible.  This is so important for survival benefit, that if the tumors are called inoperable by a local surgeon, you can and should seek expert opinion elsewhere.  What is one surgeon's "inoperable" is another surgeon's daily work.  

VATS, video assisted thoracoscopic surgery, or chest keyhole surgery, is a possible substitution for the more arduous thoracotomy, if the tumors are accessible and 3cm or less in size.   RFA, or radiofrequency ablation, is sometimes used to ablate [in this case, cook] metastases in lung, liver, and various other organs.  If the tumors are inoperable, sometimes RFA can ablate them.

There is Rusch's review article on "Pulmonary metastasectomy. Current indications"
Her conclusions are: "Complete surgical resection is critical to achieving long-term survival... The decision to proceed with the surgical resection of pulmonary metastases should be a multidisciplinary one, made jointly by the thoracic surgeon and the medical oncologist."  
&&url

Then there is the The European Organization for Research and Treatment of Cancer [EORTC] study on treatment of soft tissue sarcoma lung metastasectomies.  They concluded that "Surgical excision of lung metastases from soft tissue sarcomas is well accepted and should be considered as a  first line of treatment if preoperative evaluation indicates that complete clearance of the metastases is possible. Further investigation is needed before chemotherapy can be recommended as additional therapy." 
&&url PMID: 8616759 

"Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival <b>regardless of histological typing of the primary tumor.</b>"
&&url PMID: 11149200

CancerNet from the National Cancer Institute, has PDQ Information for Health Care Professionals about &&url .

Three more articles to bring to your attention:

<B>Metastasectomy for limited metastases from soft tissue sarcoma.</b>
Abdalla EK, Pisters PW.  Department of Surgical Oncology, MDA, Houston

"The development of metastatic soft tissue sarcoma ... is associated with a poor prognosis. Surgical resection of isolated solitary or multiple metastases is the only curative treatment; all other forms of treatment are considered palliative. ... Over the past decade, nonresectional ablative approaches have been developed to manage visceral metastatic disease. These ablative procedures include cryosurgery, radiofrequency tumor ablation, and alcohol injection. All such procedures are considered investigational; outcome should be compared to that achievable with traditional surgical metastasectomy. The optimal sequence of treatments and role for perioperative (combined with metastasectomy) chemotherapy are unknown. Given the potential curative nature of metastasectomy, all patients with metastatic soft tissue sarcoma should be evaluated for the possibility of surgical resection. Patients with good performance status who have radiographically resectable disease should be considered for metastasectomy."
&&url PMID: 12392639 


<b>Long-term results of surgical resection of lung metastases.</b>
Hendriks JM, Romijn S, et al
Antwerp University Hospital, Edegem, Belgium. 

"Between 1990 and 2000, 56 consecutive patients underwent lung resection for removal of metastatic disease. Mortality, disease-free interval, and overall survival were studied. ...Multivariate analysis showed that survival for patients who underwent 2 or more metastasectomies was surprisingly good with a 5-year survival rate of 46%. Survival was not related to disease-free interval, multiple lung metastases, or pneumonectomy. It is in accordance with some reports that a short disease-free interval, numerous lung metastases, or recurrence after the first metastasectomy should not preclude patients from operation."
&&url PMID: 11868501 


<b>Long-term results after repeated surgical removal of pulmonary metastases.</b>
Kandioler D, Kromer E, et al
University of Vienna Medical School, Austria.

"Although surgical resection is accepted widely as first-line therapy for pulmonary metastases, few data exist on the surgical treatment of recurrent pulmonary metastatic disease. In a retrospective study, we analyzed patients who were operated on repeatedly for recurrent metastatic disease of the lung with curative intent over a 20-year period. ...
From 1973 to 1993, 396 metastasectomies were performed in 330 patients. ...The 5- and 10-year survival rates after the first metastasectomy were 48% and 28%, respectively. The overall median survival was 60 months. A mean disease-free interval (calculated for all intervals, with a minimum of two) of greater than 1 year was significantly associated with a survival advantage beyond the last operation. Univariate analysis failed to show size, number, increase or decrease in number or size, or distribution of metastases as factors related significantly to survival. ...We conclude that patients who are persistently free of disease at the primary location but who have recurrent, resectable metastatic disease of the lung are likely to benefit from operation a second, third, or even fourth time."
&&url PMID: 9564899 