Postponing the limits. Multiple and repeated pulmonary metastasectomy by parenchym sparing electrocautery excision

Due to the continuous improvement and effectiveness of the chemotherapeutics, the role of the surgical resections of metastases is changing. In the period 1954-1975 we removed from 35 patients 48 metastases, in the period 1976-1985 from 45 patients 102 metastases, while in the period 1986-1989 from 47 patients 200 metastases were removed. The ratio of 1.3 metastasectomy per patient in the first group is corresponding to the 4.5 ratio metastasectomies in the last group. The number of classical lobectomies decreased in favour of the segmental and wedge resections. Based on the case histories of non seminomatous testis tumors, finally an extraanatomical resection of the metastases minimizing all unnecessary waste of functional lung parenchyma became an obvious consequence of this development. Since 1986 we adapted and used the technique of extraanatomical pulmonary resections by electrocautery 92 times. It appeared that appropriate use the cutting and coagulating modality of electrocautery offers a safe, easy, fast, highly efficient and selective tool to divide and distinguish the normal lung parenchyma from the bronchial, vascular and pathologic structures. The cautery condensed surface of the remaining parenchyma is not difficult to control for hemostasis and air leakage and can be easier sutured. In case of doubts or deep intrapulmonal defects the fibrin glue (Tissucol) offers an extra security by sealing the irregular of large defects. The microscopical examination can distinguish on the specimen a thin layer of intact lung parenchyma. The surface of this--similar of the surface of the remaining resection plane--shows a "sealed membrane" of cauterized alveoli, bronchioli or vessels.