[When and how are pulmonary metastases surgically treated in sarcomas?]

The resection of pulmonary metastases is a local treatment option for sarcomas to achieve complete remission (CR), to histologically obtain metastases and to collect tissue for further molecular pathological investigations. In selected patients with a controlled primary tumor and no evidence of extrathoracic tumor manifestations, a resection of lung metastases can be indicated in a multidisciplinary sarcoma board. The aim is the complete removal of all metastases (R0 resection) with simultaneous preservation of as much healthy lung tissue as possible. Adequate cardiopulmonary fitness for single-lung ventilation and lung resection is mandatory. Minimally invasive techniques, such as video-assisted and robotic-assisted thoracoscopy, which are primarily used for the removal of peripheral metastases adjacent to the pleura as well as an open approach are available for resection. All three procedures have no relevant morbidity and mortality. The evidence is based on retrospective case series demonstrating a survival benefit in selected patients. This article gives an overview of when and how pulmonary metastases should be surgically treated in sarcoma patients.