Long-Term Freedom from Tumours by Lung Metastasis Surgery
The diagnosis of pulmonary metastasis defines a stage IV tumour and thus quite often a poor prognosis for the patient. As a rule, palliative chemotherapy is initiated at this stage. However, it should be pointed out once again that, for some patients, there is the possibility of metastasis surgery.
Based on present retrospective data, generally favourable prognostic factors could be defined. Those factors are: the tumour histology, a long disease-free interval, a small number of metastases and a complete resection. Another prerequisite is the adequate cardiopulmonary function of the patient.
The metastasis surgery has already been included in the S3 guideline for colorectal carcinoma and the S1 guideline for osteosarcoma. To improve the data situation, which is based on retrospective analyses, two prospective randomized studies are currently run. That is the PulMiCC-Trial for colorectal carcinoma and the SMAT trial for renal cell carcinoma.
Generally recognized tumour entities are:
- Colorectal carcinoma with a five-year survival rates of 68 percent by metastases surgery
- Osteosarcoma under study protocols (EUROBOSS, EURAMOS)
- Soft tissue sarcomas, mainly due to poor chemosensitivity
- Renal cell carcinoma, in combination with tyrosine kinase and mTOR inhibitors
- Nonseminomatous germ cell tumours after chemotherapy in terms of residual surgery
- Malignant melanoma in solitary flocks and excluding further possible metastases by PET-CT
For lung metastases from other primary tumours the general indication catalogue is valid, i.e. an operation should be carried out if a local resectability in functional and technical terms is determined, provided that the primary tumour is rehabilitated or controlled and that no effective local or systemic treatment is available. In the case of singular pulmonary nodules the presence of a benign process or even lung cancer must be considered as a second tumour by differential diagnosis.
In the case of surgery a thoracoscopic wedge resection is the method of choice with superficial solitary findings. Are the findings located deeper in the parenchyma or are there several focuses a thoracotomy comes into consideration. Particularly, laser resection has proven itself as a gentle method which conserves the parenchyma.
Lung metastasis surgery can achieve long-term freedom from tumours in selected cases. The careful staging using defined prognostic factors is crucial for the selection of patients which should be done interdisciplinary.
Mareike Graff, Senior Physician Thoracic Surgery at Lung Clinic Berlin
Please do not hesitate to contact us if you have further questions.
Picture Head: Laser resected lung metastasis
News Image: Metastasis intraoperatively