title: Optimal timing of pulmonary metastasectomy--is a delayed operation beneficial or counterproductive?
abstract: BACKGROUND
  Pulmonary metastasectomy represents an established approach in the treatment of lung metastases related to several solid malignant tumors, promising the chance of long term survival. Regarding the proper timing of metastasectomy both operation promptly after diagnosis and delayed operation after an interval of 3 months are common practice.
  
  
  METHODS
  A systematic Medline search addressing the optimal timing of metastasectomy was performed. Since the search query "timing of metastasectomy" yields only a limited number of articles, the Medline search was expanded to include the main arguments for prompt metastasectomy ("metastases of metastasis", "growth rate of pulmonary metastases") and for delayed metastasectomy.
  
  
  RESULTS
  Based on the data available to date, there is no necessity to expedite the timing of the operation. On the other hand, there is no evidence that a delayed operation, for example after re-staging following an interval of 3 months, provides a benefit.
  
  
  CONCLUSIONS
  Therefore the timing of metastasectomy should only depend on the patient's requirements, such as general state of health and oncologic considerations, such as promising multimodal therapy concepts, extrathoracal tumor manifestations or oncologic type of the primary tumor. A delayed operation seems justified if the indication for resection is questionable due to a high risk of early multilocal recurrence.
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: Krueger.Marcus@mh-hannover.de.
authors.forename: M
authors.initials: M
authors.lastname: Krüger
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: J D
authors.initials: JD
authors.lastname: Schmitto
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Wiegmann
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Rajab
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Haverich
mesh_terms: D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D059146:Metastasectomy / Q000379:methods*; D011013:Pneumonectomy / Q000379:methods; D017410:Practice Guidelines as Topic; D012509:Sarcoma / Q000556:secondary / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Metastasectomy; Pulmonary metastases; Timing