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Review
. 2017 Oct;9(Suppl 12):S1291-S1298.
doi: 10.21037/jtd.2017.03.175.

Pulmonary metastasectomy: an overview

Francesco Petrella  1   2 , Cristina Diotti  1 , Arianna Rimessi  1 , Lorenzo Spaggiari  1   2
Affiliations
Review

Pulmonary metastasectomy: an overview

Francesco Petrella et al. J Thorac Dis. 2017 Oct.

Abstract

Metastasectomy is the most frequent surgical resection undertaken by thoracic surgeons, being the lung the second common site of metastases. The present oncological criteria for pulmonary metastasectomy are: (I) the primary cancer need to be controlled or controllable; (II) no extrathoracic metastasis-that is not controlled or controllable-exists; (III) all of the tumor must be resectable, with adequate pulmonary reserve; (IV) there are no alternative medical treatment options with lower morbidity. General favourable prognostic features in patients with pulmonary metastases are: (I) one or few metastases; (II) long disease free interval; (III) normal CEA levels in colorectal cancers. Negative predictive features in patients candidate to pulmonary metastasectomies are: (I) active primary cancer; (II) extrathoracic metastases; (III) inability to obtain surgical radicality; (IV) mediastinal lymphatic spread. The lack of controlled trials and studies limited by short follow-up and small cohorts did not allow to overcome some skepticism; moreover, the heterogeneity of these patients in terms of demographic, biologic and histologic characteristics represents a clear limit even in the largest series. On the basis of present knowledge, without results coming from on-going randomized trials, radical resection, histology, and disease free interval seem to be independent prognostic factors identifying a cohort of patients maximally benefitting from lung metastasectomy.

Keywords: Lung metastases; metastasectomy; pulmonary function.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Multiple, bilateral lung metastases not amenable of radical resection because of number, location and dimensions of the lesions.
Figure 2
Figure 2
Single metastasis of the right lower lobe amenable of radical resection.
See this image and copyright information in PMC

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