[Palliative surgery for primary and secondary thoracic malignancies]

Palliative thoracic surgical interventions aim to assure or to improve quality of life. They encompass surgical correction of vital complications, treatment of symptoms that limit daily activities, and prophylactic interventions to reduce symptoms and improve prognosis. Interventions are based on statistically proved results as well as on profound clinical experience in oncologic surgery. Because palliation does not intent to cure, such operations require precise patient information and inclusion of the respective patient in decision making. Operability depends on patient general condition and extent of the procedure. If tumor is resected local radicality is the principle goal also in palliative situations, which is adapted to each individual case, especially in the context of multimodal treatment strategies. One of the main indications of palliative thoracic surgery in pulmonary metastasectomy. Using the new laser technology loss of parenchyma is minimal and the rate of lobectomies is reduced from 25% to 4%. With mortality and morbidity of less than 1% the 5-year survival after complete metastasectomy is more than 30%. Tumors of the thoracic wall cause pain and tend to exulcerate; due to their obvious presence they induce anxiety. Their removal and subsequent plastic surgery of the chest wall defect therefore makes sense also in advanced stages. Palliative and curative surgery is one of the pillars in plurimodal treatment of mediastinal tumors, besides its role in obtaining tissue for histologic diagnosis. Thoracoscopic talc pleurodesis has a success rate of more than 90% in malignant effusions if the lung is fully expandable.