Surgical resection has been the first choice for the treatment of isolated pulmonary metastases secondary to extrapulmonary malignancies. Despite recent advances, systemic chemotherapy for metastatic disease without the use of surgery is considered to be merely palliative, as there are rarely long-term survivors. Criteria for resection and prognostic parameters help facilitate patient selection. In addition to the established parameters the most significant factors in selecting patients for operation include the number of pulmonary metastases, disease-free interval, serum tumour marker level, and the question of mediastinal and hilar lymph node metastases. Complete surgical resection is critical to achieving long-term survival and is best accomplished via open thoracotomy accompanied by a systematic mediastinal and hilar lymph node dissection. The recent development of video-assisted thoracoscopic surgery (VATS) and advances in thoracic imaging technique has made the VATS approach more amenable for resection of small pulmonary nodules. However, the oncological radicality of VATS is questionable for pulmonary metastasectomy, thus the VATS approach is mostly limited to diagnostic purposes and in highly selected groups of patients with limited, peripherally located lesions. These operations should be performed preferably within a prospective study setting. All results together demonstrate that resection and re-resection of pulmonary metastases can be beneficial in patients, carefully selected by a multidisciplinary tumour board of thoracic surgeons and medical oncologists.
(c) Georg Thieme Verlag Stuttgart-New York.