Does ND-YAG laser extend the indications for resection of pulmonary metastases?

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Abstract
Surgery forms part of a combined oncological concept in the managementof pulmonary metastases. The following questions are relevant for its role:Does survival depend on the type of primary tumor? Are there any prognosticfactors? What are the limits on radical resection? We analyzedretrospectively 657 patients who had undergone 759 resections of pulmonarymetastases between 1973 and 1990. After conducting in vitro and in vivoexperiments with the non-contact neodymium aluminum garnet (Nd-YAG) laserwith a generating and delivery power of 10-120 W at the site of operationfor 0.1-9.9 s, we have treated 65 patients by laser resection and/orvaporization since January 1990. Our preferred surgical approach was medianor transverse thoracotomy. The 5-year survival of all resected patients was30%, ranging from 21% (soft tissue sarcoma) to 60% (testicular carcinoma).Statistically significant differences in prognosis were seen related to thetype of primary tumor, the disease-free interval, the caval or portal typeof metastatic spread, the number of metastases and the potential degree ofradical resection. The potential degree of conventional radical resections(wedge, anatomical sub-/segmental) was negatively influenced by the numberof metastases (n ≫ 9: 79% "radical" surgery = 38% 5-year survival).Laser treatment allowed parenchyma-preserving resection in cases ofmetastases of more than 0.5 cm in diameter, and vaporization in smallerones. Resection with the intention of achieving complete remission waspossible in up to 72 unilateral metastases. The complication rate wascomparable to conventional resections.

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