For the patient in the pervious question to become an operative candidate which of the following must be met?
- Extrathoracic metastases must be able to be controlled by another modality, e.g. radiotherapy
- Tumor doubling time must exceed 40 days
- If there is recurrence at the primary site, it must be treated before the metastatic disease
- Even if effective systemic therapy is available, resection of metastases is preferred
- If pulmonary reserve is marginal, resection of the maximal number of metastatic foci should be performed
Medicine
c. If there is recurrence at the primary site, it must be treated before the metastatic disease
Answer: c There are a number of controversial areas in the area of operative approaches to metastatic disease in the lung, but there is general agreement that any extrathoracic metastases preclude eligibility for pulmonary resection. Although tumor doubling time is a measure of its aggressiveness, it is too variable to have prognostic significance and is generally disregarded as a criterion for resection. Primary site recurrence must be treated before the metastatic focus to prevent further seeding. If effective systemic therapy is available as would be expected in breast and testicular cancer or osteogenic sarcoma, it is preferred over surgical resection. Similarly, pulmonary resection should not be undertaken unless the pulmonary reserve will allow all metastatic foci to be resected.
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