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Ann Thorac Surg 1998;66:1933
© 1998 The Society of Thoracic Surgeons

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Invited Commentary

^a Department of Thoracic and Cardiovascular Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA

Invited commentary

Pulmonary resection for metastatic lung disease has been controversial since the first successful resection of pulmonary metastases by Barney and Churchill in 1938 [1]. Nonetheless, since that time many patients have benefited from this procedure and pulmonary wedge excision eventually has emerged as the procedure of choice. For this procedure to be effective, however, metastatic disease must be limited, the amount of lung removed minimal, mortality near zero, and morbidity low. Using these principles, recent 5-year survival for most cancer sites has consistently averaged 25% to 30%.

If pulmonary wedge excision is the preferred treatment, what then is the indication for pneumonectomy? In my opinion, the only indication is a solitary central lesion in a patient with a previous soft tissue or bone tumor, who has a long tumor-free interval, and who had no previous pulmonary resection for metastatic disease. And then only rarely should pneumonectomy be per-formed. Although Spaggiari and associates did not report isolated results for their 26 patients with central lesions, their operative mortality of 7.1%, complication rate of 9.5%, median survival of 6.5 months, and 5-year survival of 16.8% suggest that pneumonectomy for any more advanced metastatic lung disease should never be done.

References

1. Barney J.D., Churchill E.D. Adenocarcinoma of the kidney with metastases to the lung: cured by nephrectomy and lobectomy. Trans Am Assoc Genitourin Surg 1938;31:71.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Peter C. Pairolero Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pairolero, P. C. Search for Related Content PubMed Articles by Pairolero, P. C. Related Collections Related Article