INTRODUCTION: Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is about metastases, not lung cancer )patients, and 70% of these patients will present disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated in the lungs, and many studies investigating this technique have reported an overall 5-year survival ranging from 30-40%. The most consistent predictor of survival in these patients is complete resection. The aim of the present study was to determine the demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. METHODS: We performed a retrospective review of patients admitted in the Thoracic Surgery Department with lung metastases who underwent thoracotomy for resection following treatment of the primary tumor. Data regarding primary tumor features, demographics, treatment, and outcome were collected. RESULTS: One hundred twenty-two thoracotomies and 273 nodules were resected from 77 patients with previously treated soft tissue sarcomas. The median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the following independent prognostic factors for overall survival: the number of metastases resected, the disease-free interval, and the number of complete resections. CONCLUSION: These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection.

OBJETIVO: Identificar características pré-operatórias associadas à ressecção cirúrgica completa de tumores malignos primários do mediastino. MÉTODOS: Entre os anos de 1996 e 2006, 42 pacientes com tumores malignos primários do mediastino foram submetidos a tratamento cirúrgico com intenção curativa em uma única instituição. Dados demográficos, manifestações clínicas, características do tumor mediastinal e aspectos de invasão por métodos de imagem foram identificados através da análise de prontuários. RESULTADOS: A ressecção cirúrgica foi considerada completa em 69,1% dos pacientes. As causas de ressecção incompleta foram atribuídas à invasão das seguintes estruturas: grandes vasos (4 casos); veia cava superior (3 casos); coração (2 casos); pulmão e parede torácica (3 casos); e traqueia (1 caso). Os pacientes que foram submetidos à ressecção cirúrgica completa tiveram sobrevida global significativamente melhor que os pacientes submetidos à ressecção incompleta. A frequência de ressecção incompleta foi significativamente maior nos casos nos quais foram identificadas características radiológicas de invasão de outros órgãos além do pulmão do que nos casos cujas características eram restritas ao pulmão (47,6% vs. 14,3%; p = 0,04). Nenhuma das outras características pré-operatórias analisadas foi associada com a ressecção cirúrgica completa. CONCLUSÕES: Evidências radiológicas de invasão de órgãos além do pulmão no pré-operatório estão associadas à ressecção cirúrgica incompleta de tumores primários malignos do mediastino.

OBJECTIVE: To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. METHODS: Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. RESULTS: The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly higher in cases in which the tumor had invaded organs other than the lung (as identified through imaging studies) than in those in which it was restricted to the lung (47.6% vs. 14.3%; p = 0.04). None of the other preoperative characteristics analyzed were found to be associated with complete resection. CONCLUSIONS: Preoperative radiological evidence of invasion of organs other than the lung is associated with the incomplete surgical resection of primary malignant mediastinal tumors.

Apresentamos uma rara situação de ocorrência simultânea de dois tumores de mediastino com diferentes topografias e histologias, encontrados durante a ressecção de volumosa massa mediastinal em paciente assintomático. A possibilidade de diferentes tumores contidos numa mesma massa tumoral está relatada; entretanto, não encontramos na literatura médica relato de diferentes tumores em localizações distintas. Os bócios de tiróide intratorácicos e os timomas representam uma grande parcela dos tumores encontrados no mediastino. O tratamento cirúrgico, sempre que possível, desempenha papel fundamental na perspectiva de cura. A exploração cirúrgica minuciosa é fundamental para uma ressecção completa e possível achado de lesões concomitantes.

We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required.