Objectives
Primary thoracic synovial sarcoma is a rare, high-grade, malignancy. Involvement of vital organs is frequent and may decrease the benefits of surgical resection. We reviewed our practice at a highly experienced thoracic-surgery center to assess early and long-term outcomes after surgery.
Methods
We conducted a retrospective, observational, single-center study of patients undergoing curative-intent surgery for primary thoracic synovial sarcoma between January 1, 2000, and January 31, 2021, as part of multidisciplinary management. We assessed demographics, medical history, histopathology, and follow-up information.
Results
We enrolled 20 patients (13 males) with a median age of 40 years and a median tumour size of 11 cm. Neoadjuvant chemotherapy was administered to 13 patients. Surgery consisted in extrapleural pneumonectomy (n = 7), extrapleural lobectomy (n = 5), chest wall resection (n = 4), or tumour resection (n = 4). R0 resection was achieved in 16 (80%) patients. Adjuvant therapy was given to 13 patients. Postoperative complications developed in six patients. Median hospital stay was 11.5 days. Overall survival at 2 and 5 years was 51% and 22%, respectively; median overall survival was 25 months and median disease-free survival was 8.5 months. Relapse occurred in 15 patients. By univariate analysis, incomplete resection was the only significant predictor of survival (P = 0.01).
Conclusions
Primary thoracic synovial sarcoma is an aggressive disease. Surgery included in a multimodal treatment may contribute to achieving a good outcome, providing that an R0 resection is obtained. Given the considerable technical challenges of surgery, patient selection and referral to an experienced center are crucial to minimize morbidity and mortality.