IN 1938 Barney and Churchill1 reported the successful treatment of a patient who had a primary tumor of the kidney and an accompanying metastatic lesion in the right lung. This patient is believed to be the first successfully treated by surgical removal of the primary neoplasm and subsequent excision of the metastatic lung tumor. During the next nine years there were five reports of similar case histories in which the surgeon had deliberately undertaken to remove a pulmonary metastasis after resection of a primary neoplasm elsewhere. It has been only in recent years, however, that the philosophy of treatment of a solitary pulmonary metastasis has attracted widespread interest and promises to become an accepted surgical procedure. The most comprehensive report that has appeared in the literature to date is that of Alexander2 who collected approximately 19 unreported case histories which could be classified in this category. Blades and Effler3 in February, 1948, reported 9 cases of solitary metastasis that had been resected following the removal of the primary tumor. Considerable discussion on this subject was carried out at the meeting of the American Association of Thoracic Surgery in 1949. A complete report of the transactions will be published by that organization. The impression was gained, however, that the majority of thoracic surgeons today accept the philosophy of resection of a solitary lung metastasis in selected cases.
It has long been recognized that primary neoplasms frequently undergo a distinctive life cycle. Certain tumors have a predilection for early widespread metastases, whereas. . .