The Time of Appearance of Metastases After Surgical Removal of the Primary Tumor

IT is a common clinical observation that patients operated upon for malignant tumors may later show marked differences with respect to the length of time before metastases appear. In some patients metastases are discovered within a few months of the removal of the primary tumor while in others metastases do not become apparent until many months, or even years, after the primary tumor has been removed. Since clinical knowledge of this phenomenon is scanty and mostly has come from single case reports, it seemed that a review of the autopsy records of patients who had died of malignant tumors that had metastasized might provide useful information about the natural history of metastases and suggest possible reasons for the obvious differences in the length of time required for their development. Accordingly, the autopsy protocols of all patients with tumors who died in our Hospital over a 12-year period were analyzed with respect to the interval of time between the removal of the primary tumor and the first appearance of metastases. Analysis of these data suggests that some inherent property of the tumor may have played a part in the development of the metastases that became apparent only after a long post-operative interval.