SURGICAL-TREATMENT OF PULMONARY METASTASES IN AN INTERDISCIPLINARY CONCEPT

Surgical therapy of lung nowadays is an established procedure. Purpose of the operation is the radical and therefore potentially curative re section. Besides there are diagnostic and palliative indications. Medi an sternotomy is the standard approach for revision of both lungs even in unilateral seeming disease. Preoperative staging is not reliable c oncerning number and extention of metastases. From 1972 to 1991 843 op erations for lung metastases were carried out in 729 patients in the s urgical department of the 'Thoraxklinik Heidelberg-Rohrbach'. 30-day m ortality amounted to 2.9 %, 5-year survival rate was 33 % overall from date of metastases;resection. The best results were achieved in testi cular cancer with 67 % 5-year survival rate, poorest survival was obse rved in melanomas with 12% 3-year survival. Beside the primary tumor a nd partly dependent on it, several prognostic factors were relevant: r adicality, sarcoma vs, carcinoma in favor of carcinomas, disease-free interval, type of resection, thoracic lymph node involvement. As figur ed out by multivariate analysis, the prognostic influence of the facto rs varies considerably depending on the kind of primary tumor. Surgery of lung metastases is part of an interdisciplinary oncological therap eutical concept and offers a prolonged survival to most of the patient s and the possibility of cure to some. Even if prolongation of life is not feasible, an improved quality of life and therefore a good pallia tion is obtained.