Surgical treatment for metastatic malignancies. Pulmonary metastasis: indications and outcomes

Surgical resection is an important modality in the treatment of pulmonary metastases from various solid tumors. The criteria for pulmonary metastasectomy are as follows: (1) the patient must be a good risk for surgical intervention; (2) the primary malignancy is controlled; (3) there is no other, extrapulmonary, metastasis; and (4) the pulmonary lesions are thought to be completely resectable. The appropriate selection of candidates according to these criteria leads to an overall 5-year survival after pulmonary metastasectomy of about 30%-40%. However, most of the reported results are retrospective analyses, and the significance of pulmonary metastasectomy seems to vary according to the primary malignancy. To clarify the significance of surgical treatment for pulmonary metastases, we need further analysis of various prognostic factors, with special reference to each primary malignancy, as well as a multiinstitutional study, and randomized prospective studies, if possible.