Finding the evidence for pulmonary metastasectomy in colorectal cancer: the PulMicc trial

[Pulmonary metastases: classification and the need for staging?]

AIM

To analyze pulmonary metastases classifications which are used in Russian and foreign literature at present time.

MATERIAL AND METHODS

It is proposed the variant of pulmonary metastases staging depending on quantitative and regional prevalence of the process.

RESULTS

The development of pulmonary metastases classification is advisable to determine homogeneous subgroups of patients with metastatic lesion for prospective randomized trials in order to obtain objective results about the results of surgical or other local treatment of patients with intrapulmonary metastases.

Surgical management of lung metastases

Management of pulmonary metastases has evolved considerably over the last few decades but is still controversial. The surgical management of lung metastases is outlined, discussing the preoperative management, indications for surgery, the surgical approach and outcomes according to the primary histology.

Open Surgical Approaches for Pulmonary Metastasectomy

Surgeons differ in the approach to resection of pulmonary metastases from nonpulmonary primary malignancies, with some favoring procedures that minimize trauma to the patient, and others performing open procedures with the goal of maximizing likelihood of resection of all detectable sites of disease. This article reviews how pulmonary metastasectomy emerged as a therapy for metastatic disease. Discussed is how surgical approaches used for this procedure have evolved, the available literature addressing whether open procedures lead to more complete resections, and if so whether resection by open procedures increases the likelihood of cure following resection. The technical aspects of the various thoracotomy techniques are also reviewed.