SURGICAL-TREATMENT OF LUNG METASTASES - A N INTERDISCIPLINARY CONCERN

Surgical therapy of lung metastases is now an established procedure. T he operation's purpose is radical, and therefore potentially curative, resection. There are also diagnostic and palliative indications. Medi an sternotomy is the standard approach as it allows revision of both l ungs, which is important even when disease seems to be unilateral. Pre operative staging does not give a reliable idea of the number and exte nt of metastases. From 1972 to 1991, a total of 843 operations for lun g metastases were carried out in 729 patients in the surgical departme nt 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 testicula r cancer, with a 5-year-survival rate of 67%, and the poorest were obs erved in melanomas, with only 12% 3-year survival. In addition to the primary tumour, and in some cases depending on it, several other progn ostic factors were relevant: radicality, sarcoma vs. carcinoma (carcin oma involved a better prognosis), disease-free interval, type of resec tion, thoracic lymph node involvement. Multivariate analysis showed th at the prognostic influence of the factors varies considerably with th e kind of primary tumour. Surgical treatment of lung metastases is par t of an interdisciplinary oncological therapeutic concept offering pro longation of survival to most of the patients concerned and even the p ossibility of cure to some. Even if prolongation of survival is not fe asible, an improved quality of life and therefore good palliation are obtained.