UpToDate - Pulmonary Metastasectomy

Question 1

Contraindications to pulmonary metastases resection?

Answer 1

• brain metastases
• N2 nodal involvement (other than renal)
• inability to completely resect all areas of pulmonary involvement
• prior pneumonectomy is a relative contraindication

Question 2

Discuss disease-free interval in consideration for pulmonary metastasectomy and workup.

Answer 2

Outcomes are more favorable when there has been a longer disease-free interval between primary tumor treatment and presentation of metastatic disease; however, there is no absolute time frame (including synchronous presentation of metastatic disease) that is short enough that metastasectomy would not be considered.

Repeat chest CT six to eight weeks after recognition of pulmonary metastases to assure that additional target lesions (or too many target lesions) have not appeared

Question 3

Discuss number of lesions in consideration for pulmonary metastasectomy and workup.

Answer 3

Outcomes are better with fewer metastases. However, for patients with multiple metastases, there is no consensus among thoracic surgeons as to what disease burden represents an insurmountable obstacle. The important issue is the feasibility of resecting all sites of disease, not the absolute number of metastases per se. However, the STS consensus group considers pulmonary metastasectomy to be best suited to patients harboring three or fewer metastases.