[Surgery of pulmonary and hepatic metastases]

In recent years surgery for hepatic and pulmonary metastases has been undertaken with a curative intent in a growing percentage of cases. In the present study the Authors evaluate their own experience in such a field, and summarize the state of the art, as it appears from a review of the international literature. At present, the subject is not settled, as several aspects are matter of debate (prognostic significance of free interval, tumor doubling time, number and location of metastatic lesions, histologic type, and stage, of the primary tumor, approach to synchronous metastases, accuracy of preoperative diagnosis), with different therapeutic implications according to the hepatic or pulmonary site. Pulmonary metastases should be managed by resection through a median sternotomy, in order to allow thorough exploration of both lungs. Hepatic lesions (from colorectal primaries) should be resected with a free margin not less than 1-2 cm. The need for uniformity of selection criteria and for the establishment of protocols including adjuvant therapy is strongly felt.