Pulmonary metastasectomy

The first pulmonary metastasectomy was reported in 1882 [1]. For a period of time, resection of metastatic disease to the lung was performed only for disease discovered incidentally, usually at the time of resection of chest wall neoplasms. Eventually, as chest imaging became available, planned resection of lung metastases began to be performed. In the first series of 12 patients [2], the criteria for pulmonary metastasectomy were defined and have since been updated [3]. The primary site of disease has to be either controlled or appear controllable, complete resection of lung metastatic disease has to be feasible, the patient has to be able to tolerate planned procedures, and no better alternative treatments can be available are the criteria for resection. Several prognostic factors have been suggested from reviews of retrospective patient series. The most important analysis of these was performed by The International Registry of Lung Metastasis, which reported outcomes and associated prognostic factors for 5,206 patients of all histologies from a database which combined retrospectively and prospectively gathered data [4]. The 5‐year overall survival for all histologies was 36%. Extended disease‐free interval (DFI) (i.e., more than 3 years), a limited number of lung metastases (i.e., one nodule), and completeness of resection were found to be predictors of favorable outcomes. Most recently, The European Society of Thoracic Surgeons (ESTS) formed the LungMetastasectomyWorking Group to produce guidelines based on all available evidence [5]. They concluded the level of evidence is insufficient for guidelines and noted that randomized controlled trials have not been completed. At present, pulmonary metastasectomy is offered to patients based on the observation that long‐term survival can be seen after resection, while long‐term survival with systemic therapy alone as treatment for patients with pulmonary metastases appears extremely rare.