[Surgical therapy of lung metastases. An interdisciplinary responsibility]

Surgical therapy of lung metastases is now an established procedure. The operation's purpose is radical, and therefore potentially curative, resection. There are also diagnostic and palliative indications. Median sternotomy is the standard approach as it allows revision of both lungs, which is important even when disease seems to be unilateral. Preoperative staging does not give a reliable idea of the number and extent of metastases. From 1972 to 1991, a total of 843 operations for lung metastases were carried out in 729 patients in the surgical department of the Thorax Clinic in Heidelberg (Rohrbach). The 30-day mortality was 2.9%, and the overall 5-year survival from the date of resection of the metastases was 33%. The best results were achieved in testicular cancer, with a 5-year-survival rate of 67%, and the poorest were observed in melanomas, with only 12% 3-year survival. In addition to the primary tumour, and in some cases depending on it, several other prognostic factors were relevant: radicality, sarcoma vs. carcinoma (carcinoma involved a better prognosis), disease-free interval, type of resection, thoracic lymph node involvement. Multivariate analysis showed that the prognostic influence of the factors varies considerably with the kind of primary tumour. Surgical treatment of lung metastases is part of an interdisciplinary oncological therapeutic concept offering prolongation of survival to most of the patients concerned and even the possibility of cure to some. Even if prolongation of survival is not feasible, an improved quality of life and therefore good palliation are obtained.