[Surgical indications for lung cancer: influence of the M factor]

The presence of distant metastasis indicates systemic dissemination of disease. Patients with lung cancer in this category are not usually considered candidates for surgical resection of the primary and metastatic sites, although newly emerging treatment modalities for lung cancer improve survival. We need to conduct clinical trials in patients with distant metastases. We conducted a retrospective analysis of the surgical outcome of 16 PM2 patients who are now classified as having M1 disease. The 3-16 year survival rate was 45% and 5-year survival rate 14% in our facility. Among the 11 patients had N2 disease and a poor prognosis. Long-term survival can be achieved if the histology shows low grade malignancy and there is no lymph node involvement (N0 status). Patients with solitary brain metastasis also have a poor outcome even after surgical resection of both the brain metastasis and primary lung cancer. In this group, surgical intervention should be restricted to those in whom the quality of life is expected to improve, since it has been reported that no improvement in survival can be expected. We should investigate which patient groups can achieve long-term survival when surgically treated. The TNM classification had better be revised so that patients who benefit from simultaneous lung and metastatic resection are classified in earlier-stage groups.