Pulmonary Metastasectomy in Solid Tumors: A Single-Center Experience at a Tertiary Referral Center in the Middle East

Background: Despite advances in systemic therapy, pulmonary metastasectomy remains a key option for selected patients with metastatic solid tumors, offering long-term survival. Prognosis is influenced by many factors including disease-free interval and metastatic burden. This study evaluates survival outcomes and prognostic factors in a mixed-tumor cohort from a Middle Eastern tertiary cancer center. Methods: This retrospective cohort study included all patients who underwent pulmonary metastasectomy for solid tumors at King Hussein Cancer Center between October 2014 and December 2024. Demographic, clinical, imaging, surgical, pathological, and follow-up data were collected from electronic medical records. OS and P-RFS were estimated using Kaplan-Meier analysis, and prognostic factors were assessed using Cox proportional hazards models. Analyses were performed using SPSS version 27. Results: A total of 236 patients underwent 371 procedures. The mean follow-up was 31.9 months (95% CI:28.3-35.3). Median OS was 3.99 years (95% CI:2.69–5.28), with a 5-year OS rate of 42.0%. Mean P-RFS was 6.81 years (95% CI: 6.16–7.46), with the median not reached. On univariate analysis, worse OS was associated with nodule size ≥3 cm, bilateral metastases, thoracotomy, longer hospital stay, and increased tumor burden. R0 resection and DFI ≥12 months were protective. In multivariate analysis, independent predictors of worse OS were nodule size ≥3 cm (HR: 1.827, p=0.015) and DFI <12 months (HR for ≥12 months: 0.515, p=0.002). Conclusion: Pulmonary metastasectomy is an established treatment option for patients with lung metastasis from different solid tumors that provides durable long-term and pulmonary recurrence-free survival in appropriately selected patients. Longer DFI and lower metastatic burden independently predict improved outcomes.