Surgical Treatment of Pulmonary Metastasis

The first surgical resection of single lung metastases was reported by Weinlechner in 1882. This metastatectomy was done for a discrete pulmonary metastases which was discovered during resection of a chest wall sarcoma (1). The patient died on the first day after surgery. One year later, Kronlein performed same operation successfully (2). During surgery of a recurrent sarcoma of the chest wall in an 18-year-old girl, he noticed a pulmonary metastases in the size of a walnut. He removed it with a wedge resection and the patient survived for 7 years later but unfortunately died due to a second recurrence. In spite of this successful metastatectomy, there was a long period of suspicion about metastatectomy among physicans. It was considered that the presence of metastasis indicates spreading of the disease so that, surgery is not useful. In spite of this belief, many efforts were done for surgical treatment of patients with pulmonary metastases (3,4). The advent of chemotherapy during 1960-70 caused an important impact on the treatment of pulmonary metastases. The majority of patients suffering from different malignancies survived for a longer period of time by this method, and some of them referred with solitary and removable pulmonary metastasis. In addition, the surgical methods were improved, and postoperative mortality was decreased. Nowadays, pulmonary metastasectomy is a part of treatment in most malignancies, and controversies are only with regard to operation indication and selection of patients. This procedure had good results in numerous reports (510). Nevertheless, the total cure rate is around 20%, and successful results have been reported mainly in selected patient groups. Thus, we do not recommend metastasectomy as a routine procedure in all patients who have metastases. With good selection of patients and surgical approaches, nearly one third of all patients presenting with pulmonary metastases as the only site of the disease may benefit from resection of their metastases. (Tanaffos 2003; 2(6): 7-24)