Chirurgie des métastases pulmonaires d’hier à aujourd’hui

Abstract

Surgical resection of lung metastases may prolong survival as a part of multimodality treatment. Our aim was to review how the indications and practice of this type of surgery have evolved over time. We included in the study all patients who were operated for this indication between 1983 and 2006 in two different surgical departments. A retrospective review was conducted including the following criteria: age, sex, type of primary cancer, type of pulmonary resection, histology of metastases, perioperative chemotherapy. Four hundred and seventy-two operations were performed in 225 men and 145 women: 448 were complete resections (wedge resection: 221, segmentectomy: 47, lobectomy: 148, pneumonectomy: 32), and 24 incomplete resections. Most metastases were from colorectal (n=129), renal (n=73), and sarcoma origin (n=34); the survival rate was 38.5% and 24.3% at 5 and 10 years. The following criteria were markers of poor prognosis: incomplete or large excision (whole lung or lobar excision), size, nodal status, intravascular microemboli. Factors that did not influence prognosis were: disease free interval, location and number of metastases. Prognosis showed a significant improvement since 1998, and with the use of neoadjuvant chemotherapy (77 patients). The survival rate for isolated metastases that were potentially candidates for radiofrequency ablation was 48% at 5 years. The prognosis of lung metastases has been notably improved by better understanding of the disease and the adoption of a multidisciplinary approach, integrating recent advances in systemic treatments. The efficacy of other forms of local surgical treatment have yet to be demonstrated.