Results of surgical treatment of pulmonary metastases

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Abstract
Surgical removal of one or several metastases with a potentiallycurative aim is possible in the case of isolated pulmonary metastases.Surgery is part of a combined oncological concept. Between 1972 and 1986,surgical resection was indicated in 368 patients and 419 thoracotomies werecarried out. Of the patients, 38% had more uni- or bilateral metastasesthan expected even after the most careful preoperative diagnosticexaminations. The 5-year survival probability of all patients operated onwas 33%. Corresponding to a differentiation between potentially curativeand non-curative resections, the operation was classified as potentiallycurative in 73%. In this group, the 5- year survival was 39%.Differentiation into tumour groups (carcinomas of caval type, carcinomas ofportal type and sarcomas) revealed no statistically significant differencesin prognosis. Due to the excellent chemotherapeutical regimens, testicularteratomas achieved the best results in the early postoperative years.Long-term survival is decisively influenced by the removal of all visibleand palpable metastases. If complete removal of all tumour tissue ispossible, the number of metastases does not influence survivalsignificantly. Besides radicality, the duration of the disease-freeinterval showed prognostic differences which were statistically significant(P less than 0.001). Considering the metastatic route and the type ofprimary tumour, there were slight prognostic differences which were notstatistically significant. Recently, the median sternotomy has become thepreferred method of access. Predominating resection procedures are wedgeand segmental resections which yield the best survival rates.

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