[The surgery of pulmonary metastases. The surgical indications and technical aspects of lung resections for metastases].

Surgery for pulmonary metastases is an accepted method of treatment for many kinds of malignant neoplasms, because of favorable results in five-year and ten-year survival. At present several technical aspects are being debate (operative indications, method of thoracic access, procedure of lung resection, approach of bilateral lesions), with the aim of improving the number of patients undergoing radical excision of all pulmonary metastatic foci. The present paper summarizes a recent experience (1989-1992) in the treatment of pulmonary metastases in 55 patients, with special reference to tactical and technical problems related to metastasectomies. The primary tumor was an osteogenic sarcoma in 28 cases (51%), other musculoskeletal and soft tissue sarcoma in 20 (36%), and epithelial neoplasms in 7 (13%). In 47 patients (85%) the discovery of pulmonary metastases was metachronous regarding primary malignancy, with a range of between 3 months and 17 years; in the other 8, lung disease was simultaneous with diagnosis of neoplasm. All patients underwent preoperative standard chest X-ray, thoracic computerized tomography and lung function assessment; the radical control of primary neoplasm and the absence of any extrapulmonary metastases were required for thoracotomy. Pulmonary nodules were single in 21 patients (38%), multiple ipsilateral in 16 (29) and bilateral in 18 (33%). The thoracic approach was a muscle-sparing thoracotomy (axillary vertical thoracotomy) in 51 patients, other thoracotomies in 3 and a median sternotomy in 1 patient. The operative procedures were 19 single wedge resections (35%), 27 multiple wedge resections (49%), 1 lobectomy (2%), 1 lingulectomy (2%) and finally 7 exploratory thoracotomies (12%) for different reasons. In patients with bilateral disease, a bilateral synchronous thoracotomy and multiple wedge resection was performed 13 times, while staged thoracotomy was necessary in 2 and a median sternotomy was preferred in 1 case; 2 patients received a monolateral axillary exploratory thoracotomy. A total of 186 lung nodules were excised, but only in 161 (86%) the histologic examination confirm the metastasis. There was no operative mortality and the postoperative complications were few. Based on this experience, the authors believe that every neoplastic patient with pulmonary metastases, certain or suspected, should be considered for thoracotomy, since metastasectomy is a very safe procedure today.(ABSTRACT TRUNCATED AT 400 WORDS)