Pulmonary metastases—Principles principles and strategies of surgical treatment

Abstract

Surgical therapy of pulmonary metastases has become an established concept in tumor treatment as therapeutic alternatives are often missing and risks are acceptably low. Reviewing literature and analysing own experience the challenge for an oncological surgeon pursuing a multimodal concept in the treatment of pulmonary metastases is demonstrated. Between August 1989 and December 1993 155 patients had been operated on pulmonary metastases from extrapulmonary malignomas, with 125 of them having a carcinoma as primary malignanyy. Among them most had colorectal cancer (n=37), cancer of the kidney (n=32), the testicles (n=17) and the breast (n=14). In the 209 operations performed the mortality is zero. In case of multiple and/or centrally sited metastases unilateral thoracotomy one by the other seems an appropriate operative management. Prognosis after surgical resection of lung metastases is in general better for carcinoma than for sarcoma patients. Within the group of carcinomas patients with testicular carcinoma show a good prognosis (all our 17 patients are still alive). Important prognostic factors are completeness of surgery and hilar lymph nodes free of tumor in colorectal and kidney cancer metastases of the lung. Median survival time in patients with metastases of colorectal-, kidney-and breast carcinoma is 48 months, 51 months respectively 61 months. Surgical resection is the importance of a curative therapeutic attempt in the treatment of pulmonary metastases. To value the importance of the several therapeutic approaches in a multimodal treatment concept and to adapt them to the different tumor classes, prospective trials with a sufficiently large number of cases are required. With this it might be possible to derive tumor dependent concepts for a multimodal therapy, like the ones which already exist for the treatment of pulmonary metastases of germ cell tumors.