Surgical treatment of metastatic lung tumors — Recent changes in techniques and indications

Between 1969 and 1995, 180 patients underwent complete resection of lung metastases during initial thoracotomy at our institute, involving the resection of 917 pulmonary nodules at 202 thoracotomy procedures. The overall postmetastasectomy 5- and 10-year survival rates were 46% and 30%, respectively. Of 111 patients who underwent segmentectomy and/or local excision, 57 had multiple metastases, 39 of whom were treated by Nd:YAG laser after 1986, and 18 by conventional procedures before 1985. The average number of tumors resected per patient treated with the Nd:YAG laser was significantly greater than that of those treated with conventional procedures. However, the survival curve of the laser-treated group was better than that of the laser-nontreated group. Moreover, slightly better survival was achieved in patients operated on after 1992 compared with those operated on before 1991. We conclude that the laser technique may be warranted to afford complete resection of metastases and adequate pulmonary reservation in combination with a selected approach for thoracotomy under the exact detection of tumor localization using the most recent high-quality computed tomography (CT) scan. Furthermore, a one-stage operation to control synchronous intra- and extrapulmonary malignamcies may become a possible option in combination with selective adjunctive therapy.