Methods: We reviewed all surgically treated patients with SFP at our institution from December 1972 through December 2002.

Results: There were 86 patients (39 men and 47 women). Median age was 59 years (range, 34 to 83 years). Forty-eight patients (56%) presented with symptoms which included chest pain in 15, cough in 8, dyspnea in 5, other in 12, and multiple symptoms in 8. Hypertrophic pulmonary osteoarthropathy was present in 20 patients (23%), clubbing in 17 (20%), and hypoglycemia in 1 (1%). The operative approach was posterolateral thoracotomy in 69 patients, thoracoscopy in 12, sternotomy in 4, and laparotomy in 1. Resection of the SFP was accomplished by a pulmonary wedge excision in 64 patients, lobectomy in 4, segmentectomy in 2, chest wall resection in 3, and pleura resection in 7. Chest wall resection combined with pulmonary wedge, lobectomy, or pneumonectomy was performed in 3, 2, and 1 patient respectively. SFP was polypoid in 66 patients (77%) and sessile in 20 (23%). SFP was benign in 74 patients (86%) and malignant in 12 (14%). Eleven patients (92%) with a malignant SFP were symptomatic whereas 40 patients (54%) with benign SFP were symptomatic (p=0.02). Overall median tumor diameter was 5.0 cm (range, 0.8 to 30); 12.5 cm for malignant SFP and 4.5 cm for benign (p<0.001). There was 1 operative death (1.2%). Complications occurred in 7 patients (8%). Median follow up was 142 months (range, 23 to 387). Median survival was 51 months for patients with a malignant SFP versus 284 months for patients with benign SFP. Five-year survival for malignant and benign SFP was 42% and 89% respectively (p<0.001). Overall, 5-year freedom from recurrence was 94%. Ten patients (12%) developed recurrent SFP. Seven recurrences (70%) were malignant SFP and 3 benign (30%). Recurrences were diffusely metastatic in 6 patients and localized in 4. All localized recurrences were re-resected with recurrence again in 3.

Conclusion: Resection of benign SFP has an excellent long-term prognosis. Increased tumor size and the presence of preoperative symptoms suggest malignancy. Prolonged survival following resection of malignant SFP is possible; however, recurrence of SFP is an ominous finding.