[Interdisciplinary concepts and long-term results after surgery of pulmonary metastases]

From January 1976 to December 1988, 338 patients with pulmonary metastases underwent 376 resections. For 26 patients with recurrent disease a second or repeated thoracotomy was necessary. The operative mortality was for isolated lesions under 1%, for multiple bilateral nodules 3.8%. A parenchymal saving resection was performed, except for metastases from colorectal carcinoma, who often involved the bronchopulmonary lymphatic nodules. In these cases (30%) a segmentectomy or lobectomy was indicated. The five-year survival rates was significantly favorable for patients with isolated lesions, specially for late uterine metastases (57%), late mammary metastases (45%) and head and neck metastases (60%). The adjuvant hormones substitution and chemotherapy for multiple uterine and mammary metastases leaded to favorable results (prolonged median survival of 18 months). The indication for resection of multiple ipsilateral or bilateral lesions from testicular cancer, soft tissue and osteogenic sarcomas were recommended only when there was no response or partial response to the chemotherapy. The five-year survival was 46%, 27% and 17% approximately. The disease-free interval, location of the pulmonary lesions and the stage of primary cancer had not influenced on post-thoracotomy survival. The metastatic route of primary cancer, caval or portal route, size and number of metastases and the tumor doubling time was significantly associated with postoperative survival.