[Results of surgical treatment of lung metastases]

Surgical removal of one or several metastases with a potentially curative aim is possible in the case of isolated pulmonary metastases. Surgery is part of a combined oncological concept. Between 1972 and 1986 surgical resection was indicated in 368 patients and 419 thoracotomies were carried out. 38% of the patients showed more uni- or bilateral metastases than expected after the most careful preoperative diagnostic examinations. The 5-year survival probability of all operated patients was 33%. Corresponding to a differentiation between potentially curative and non-curative resections the operation was classified as potentially curative in 73% of the cases. In this group the 5-year survival rate amounted to 39%. Differentiation into tumor (carcinomas of caval type, carcinomas of portal type and sarcomas) revealed no statistically significant differences of prognosis. Thanks to the excellent chemotherapeutical regimens, testicular teratomas showed the best results in the first postoperative years. Long-term survival is decisively influenced by the removal of all visible and palpable metastases. If complete removal of all tumor tissue is possible the number of metastases do not influence survival significantly. Besides radicality the duration of the disease-free interval showed prognostic differences which were statistically provable (p less than 0.0001). Depending on the metastatic route and primary tumor type there were slight prognostic differences which were not statistically significant. Within the last years median sternotomy became the preferred access. The main resection procedures are wedge and segmental resections which yield the best survival rates.