To evaluate surgical results of resection of second (recurrent) pulmonary metastases from adult soft tissue sarcoma, the survival of 39 patients was analyzed retrospectively. With the exclusion of two patients (one with interval metastases between staged resections and one without histologically proved metastases), three patients were found to have unresectable disease (median survival, 7 months). A significantly (P = 0.0001) longer median survival (28 months) was found for 34 patients whose recurrent metastases were completely resected. The only other factor predicting significantly longer post-thoracotomy survival was resection of a solitary metastatic nodule (median survival, 65 months). Patients who had two or more recurrent nodules resected had a median survival of 14 months only (P = 0.01). Although trends toward longer survival were noted for other prognostic factors, none reached statistical significance. We conclude that the complete resection of a solitary second (recurrent) pulmonary metastatic nodule from adult soft tissue sarcoma predicts long-term survival.