Preoperative evaluation and indications for pulmonary metastasectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Pulmonary metastasectomy (PM) is a key treatment for lung metastases, improving long-term survival.
• New therapies like SBRT, immunotherapy, and targeted therapy necessitate re-evaluation of PM indications.

Purpose of the Study:

• To review preoperative evaluation and indications for pulmonary metastasectomy in the current treatment landscape.
• To emphasize the importance of physiological and oncological assessments for PM eligibility.

Main Methods:

• Review of preoperative evaluation components: history, physical, physiological, and radiological examinations.
• Analysis of general criteria for PM: patient condition, primary tumor control, absence of extrapulmonary metastases, and complete resectability.
• Consideration of tumor-specific prognostic factors and disease-free interval (DFI).

Main Results:

• Radiological exams are crucial for differential diagnosis, nodule assessment, and detecting extrapulmonary metastases.
• General PM criteria include good patient health, controlled primary cancer, no distant spread, and resectable lung lesions.
• Observation may be preferred for patients with poor prognostic factors or short DFI.

Conclusions:

• PM indication requires careful physiological and oncological assessment.
• Multidisciplinary discussion is essential for optimal decision-making regarding PM.
• Tailoring PM decisions based on individual prognostic factors and evolving treatment options is critical.