Surgical treatment of metastatic diseases to the lung

The problem of treating secondary cancer is very controversial. Huge progress in its treatment began in the 1970s with the introduction of chemotherapy. In the surgical aspect Pastorino's work published in 1997 was a milestone. To this day, most authors cite its research results.

The task is to answer the question what tactics to follow in the surgical treatment of patients with secondary cancer affecting the respiratory system.

Retrospective studies were conducted on a group of 577 patients. Men prevailed slightly. The average age was 56 years. Surgical access used in the vast majority of cases was anterolateral thoracotomy. Wedge resection was the most common scope of surgery. Lymph nodes were not removed as standard. Single and multifactorial statistical surveys were conducted (Kaplan-Meier estimator and multifactorial Cox regression analysis).

A total of 1,058 operations were performed during which 1889 metastases were removed. Negative tissue margins were obtained in 90.4%. The median survival was 47 months. Complications occurred in 76 patients, which constituted 7.1% of performed procedures. There were 3 perioperative deaths.

It was found that the factors negatively affecting survival were lack of radicalism, size of the metastasis > 3 cm, and number of metastases > 1. The factors positively influencing survival were a longer time than primary surgery and a greater number of operations. Histological diagnosis differentiated patient survival.