title: [Surgical treatment of pulmonary metastasis: diagnostic protocol and individualization of indication criteria].
abstract: Lung is the second most frequent site of cancer metastasis (29% of autopsies). At the present time, surgery is the only potentially curative treatment available to patients with no other secondary localizations. Solitary or multiple, unilateral or bilateral, and synchronous or metachronous appearing pulmonary shadows, in cancer patients, give rise to both diagnostic and therapeutic problems. Diagnostic methods are selected by sensibility and specificity. The most sensitive is the thoracic C.T. (sens. 94%; spec.: 76%) and the most specific is fine needle biopsy (sens.: 92%; spec.: 98%). These two tests alone provide diagnostic certainty in 97-100% of cases, including small (3-6 mm) subpleural and multiple lesions. Tomography, bronchoscopy or Ga-67 scanning are indicated only in selected cases. Selection of patients for surgical treatment is based on: 1) tumors almost exclusively producing pulmonary metastasis (soft tissue sarcomas, renal, head and neck cancers); 2) tumor-free time (1 year considered good long) 3) length of doubling time (+40 days). This selection criteria also applies to multiple and/or bilateral lesions. Surgical treatment consists of surgical excision with minimal parenchymal sacrifice. Long-term follow-up after metastasectomy, shows a considerable improvement in both the survival period and residual quality of life in comparison to patients not surgically treated, or treated by chemotherapy alone.
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed
vernacular_title: Il trattamento chirurgico delle metastasi polmonari: protocollo diagnostico ed individuazione dei criteri di indicazione.