[Resection of pulmonary metastases: indications, surgical technic, results and prognostic factors].

One hundred and ninety six thoracotomies were performed on 152 patients with pulmonary metastases up to 1988 in the Second Surgical Department, University of Vienna. Age ranged from 2 to 78 years, 13 patients were younger than 18 years. The primary tumour was carcinoma in 103 cases, sarcoma in 38 cases and melanoma in 11 cases. The primary tumour in young patients was osteosarcoma in 7 cases, Ewing sarcoma in 2 and Wilms tumour in 2 cases. With a minimal follow-up period of 2.5 years the actuarial 5 years survival rate of 37% was observed for carcinoma, and 29% for sarcoma patients. A statistical difference was found between the carcinoma and sarcoma groups with respect to survival rate; the prognosis for patients with melanoma was markedly worse. A prognostic factor was the duration of disease-free interval in carcinoma patients. Actuarial post-thoracotomy survival in patients with osteogenic sarcoma was 32% at 5 years and only 10% in the soft-tissue sarcoma group. Size of lesions, vitality of the metastases and disease-free interval correlated with survival in the osteogenic group, whilst the number of lesions was of importance in the soft-tissue group. On account of the lesser functional morbidity and the ability to assess both lungs for exploration, palpation and resections, the importance of median sternotomy is constantly increasing for the treatment of pulmonary metastatic disease and the results justify an aggressive approach. In those cases which the primary tumour is sensitive to chemotherapy the procedure of metastatic resection must be incorporated into the general scheme of oncological therapy.