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Lung Metastases

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Extreme Hepatic Surgery and Other Strategies

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Abstract

Surgical resection of pulmonary metastases is well established and widely accepted, most commonly for colorectal cancer. It is indicated when the primary tumor is controlled, the lung metastases are considered completely resectable, the patient has an adequate pulmonary function to undergo the planned resection, and, in the case of extrapulmonary metastases, these also are resectable. Wedge resection is the most common procedure, but larger lung resections, even associated with resections of neighboring structures, may be indicated if the resection can be complete. Intraoperative nodal assessment is mandatory, as nodal involvement has a deleterious prognostic effect. It is generally accepted that overall survival can be improved by pulmonary metastasectomy especially when the primary tumor is controlled and the operative risk is acceptable. However, the evidence of the effectiveness of metastasectomy is only based on registry data and surgical follow-up studies. On an individualized basis, adjuvant chemotherapy may be considered. Loco-regional chemotherapy delivers larger doses of drug into the lung with little or no systemic side-effects, and is being investigated in animal models and in clinical trials. While awaiting a future randomized trial that can answer which is the precise impact of surgery in lung metastases from colorectal cancer, this type of practice should be part of the concept of personalized treatment for advanced cancer.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Hospital Universitari MútuaTerrassa, Plaza Dr. Robert, 5, 08221, Terrassa, Barcelona, Spain

    Sergi Call MD, PhD, FETCS & Ramon Rami-Porta MD, PhD, FETCS

  2. Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain

    Sergi Call MD, PhD, FETCS

  3. CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain

    Ramon Rami-Porta MD, PhD, FETCS

  4. Department of Thoracic Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain

    Raul Embun MD, PhD

  5. Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Antwerp, Belgium

    Paul Van Schil MD, PhD

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  1. Sergi Call MD, PhD, FETCS
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  2. Ramon Rami-Porta MD, PhD, FETCS
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  3. Raul Embun MD, PhD
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  4. Paul Van Schil MD, PhD
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Correspondence to Sergi Call MD, PhD, FETCS .

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  1. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Eduardo de Santibañes

  2. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Victoria Ardiles

  3. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Fernando A. Alvarez

  4. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Virginia Cano Busnelli

  5. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Martin de Santibañes

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Call, S., Rami-Porta, R., Embun, R., Van Schil, P. (2017). Lung Metastases. In: de Santibañes, E., Ardiles, V., Alvarez, F., Busnelli, V., de Santibañes, M. (eds) Extreme Hepatic Surgery and Other Strategies. Springer, Cham. https://doi.org/10.1007/978-3-319-13896-1_21

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  • DOI: https://doi.org/10.1007/978-3-319-13896-1_21

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