Evolution of the surgical management of pulmonary metastases.

Surgical treatment of pulmonary metastases dates back to the late 19th century. However, for the ensuing 50 years, the number of cases operated upon were few. Since the 1960s, the eligibility of patients for resection of pulmonary metastases has broadened. Neither the number of lesions nor the length of the disease-free interval excludes a patient from resection provided the primary tumor has been treated adequately and the patient can tolerate the resection. Resection of pulmonary metastases is predicated on the absence of effective treatment of nonoperative means and the ability to safely and completely resect all tumor and yet conserve sufficient lung tissue to provide a good quality of life. Major areas of controversy that remain are the number of metastases amenable to complete resection, the disease-free interval, the applicability by tumor type, and the role of chemotherapy. The data published to date suggest that pulmonary resection for metastases can improve overall survival with minimal morbidity and mortality.