[Place of surgery in the treatment of lung metastases from colorectal cancers].

The authors analysed the five main series reported in the literature exclusively devoted to surgical treatment of lung metastases of colon and rectum cancers and their own experience. The classical indications, limited to solitary lesions, have been extensively modified, and resection of bilateral lesions, recurrent lesions and pulmonary lesions in patients previously operated for other extrathoracic metastases is now possible. The 5-year survival rates vary between 20 and 44% in the various series. The complete nature of the resection is an essential prerequisite to prolonged survival. The other prognostic factors are discussed: presence of lymph node invasion or raised CEA appear to carry a poor prognosis. On the other hand, the type of resection performed, the disease-free interval, the repeated nature of the pulmonary resection and the presence of previously operated extrathoracic metastases do not appear to influence survival. Opinions differ concerning the prognostic significance of disseminated pulmonary lesions, particularly when complete resection is possible. These results confirm the special place of surgery in the treatment of lung metastases of colon and rectum cancers. The operative indications are still difficult to define, but the relatively benign nature of this surgery justifies an extension of the indications.