علاج النقائل الرئوية في المرض قليل الانتشار مع ما يصل إلى خمس آفات رئوية

References

DOI: 10.21037/asj-21-81

• In order to consider a patient eligible for pulmonary metastasectomy, the following criteria have been suggested: (I) the patient is fit for surgery; (II) the primary tumor has been resected or is under control; (III) no extra-thoracic metastases are present or, if present, they can be treated with radical intent; (IV) the thoracic surgeon is able to perform a macroscopic complete resection; (V) an adequate residual pulmonary function is expected after surgery; (VI) no other treatments with reduced morbidity and similar benefits are available.
• Despite inconsistencies among different clinical studies, the limit of five lesions can be accepted for oligometastatic state, provided that all the lesions can be radically treated.
• For lung metastases, sub-lobar wedge excisions are preferred as most of these are hematogenous metastases in contrast to early primary lung cancer <2 cm, for which anatomical segmentectomies are indicated.
• Additionally, for the management of pulmonary metastases, in contrast with primary lung cancer, lobectomy is not required for oncologic reasons, although anatomical reasons (such as the size or number of lesions) might make it necessary.
• In this population, the use of adjuvant chemotherapy after metastasectomy strongly affected OS compared to surgery alone (HR =0.35; P=0.014).