Current role of interdisciplinary strategies in the treatment of pulmonary metastases
Lung metastasectomy is still the best treatment option for resectable patients improving overall survival and providing low morbidity and mortality. Preoperative imaging still has an insufficient sensitivity and a poor specificity. Therefore a pure thoracoscopic approach for metastasectomy providing even lower morbidity but precluding palpation remains controversial. Prognostic factors are currently not recommended to select patients for surgical therapy but might be of value to select patients who benefit from neoadjuvant or adjuvant therapy. The role of chemotherapy in lung metastases is still undefined. Considering the low efficiency of current regimes the risk/benefit ratio as well as the cost/effectiveness ratio is in favour of surgery. Until now surgical resection when feasible provides survival rates superior to any available nonsurgical therapy.