SURGICAL-TREATMENT OF METASTATIC LUNG-TUMORS - RECENT CHANGES IN TECHNIQUES AND INDICATIONS

Between 1969 and 1995, 180 patients underwent complete resection of lu ng metastases during initial thoracotomy at our institute, involving t he resection of 917 pulmonary nodules at 202 thoracotomy procedures, T he overall postmetastasectomy 5- and 10-year survival rates were 46% a nd 30%, respectively. Of 111 patients who underwent segmentectomy and/ or local excision, 57 had multiple metastases, 39 of whom were treated by Nd:YAG laser after 1986, and 18 by conventional procedures before 1985, The average number of tumors resected per patient treated with t he Nd:YAG laser was significantly greater than that of those treated w ith conventional procedures, However, the survival curve of the laser- treated group was better than that of the laser-nontreated group. More over, slightly better survival was achieved in patients operated on af ter 1992 compared with those operated on before 1991, We conclude that the laser technique mag be warranted to afford complete resection of metastases and adequate pulmonary reservation in combination with a se lected approach for thoracotomy under the exact detection of tumor loc alization using the most recent high-quality computed tomography (CT) scan, Furthermore, a one-stage operation to control synchronous intra- and extrapulmonary malignancies may become a possible option in combin ation with selective adjunctive therapy.