Results in surgery of pulmonary metastases

Nowadays surgical treatment of pulmonary metastases is a generally accepted therapeutic concept. Between 1973 and 1991 surgical resection was indicated in 655 patients, and 752 thoracotomies were carried out including 65 laser resections. Median sternotomy has become the preferred access, as the preoperative staging is not exact enough concerning the number of the metastases. This access offers the possibility to examine both lungs during the operation. In 521 operations, wedge resections were carried out, in 199 operations, a lobectomy was necessary. Overall 30-day mortality amounted to 2.8%. The probability to survive 1 year amounted to 71%, to survive 3 years to 42% and to survive 5 years to 31%. Irrespective of the primary tumour, the radicality of the operation is a statistically prognostic factor. Carcinomas showed better prognosis than sarcomas. The isolated examination of the different groups of primary tumors (mammary carcinomas, testicular carcinomas, hypernephromas, melanomas, colorectal carcinomas, osteosarcomas and soft tissue sarcomas) revealed a different influence of various prognostic factors, e.g. the number of metastases and the disease-free interval. Surgery of pulmonary metastases is part of an interdisciplinary concept of oncological therapy, which offers a prolongation of life to most patients and cure to some. If a prolongation of life cannot be achieved, an improvement of life quality can be obtained by surgical treatment.