Pulmonary metastasis: rationale for local treatments and techniques.

The indication for pulmonary metastasectomy has been postulated based on nonrandomized clinical experiences. The postoperative survival rate of selected patients with pulmonary metastasis is acceptable; nevertheless, pulmonary metastasectomy might cure patients if the neoplastic cells are located only in the lung parenchyma. Computed tomography has been the most reliable preoperative diagnostic methods for identifying pulmonary metastasis. However, it has the limitations that small nodules often cannot be detected, or they are overestimated. Through thoracoscopy, which has largely been applied for metastasectomy in Japan, bimanual palpation during surgery cannot be performed. Considering the fact that the survival rate of the patients undergoing thoracoscopy is not significantly different from that of the patients undergoing conventional thoracotomy, pulmonary metastasectomy is a suboptimal method for eradicating the disease. Less invasive local therapy may be promising for repeat local intervention.