Surgery for Metastatic Neoplastic Disease in the Lung

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METASTATIC neoplastic disease in the lung ordinarily is not a surgical problem. The consideration of surgery arises only under exceptional circumstances. The lungs are a common site of metastatic neoplasms. This frequency is readily explainable on anatomic and physiologic bases. Roentgenography offers unique ability to screen the lungs for disease of many types, and has certainly served to emphasize the frequency of pulmonary metastatic neoplastic disease. The routine use of roentgenograms of the chest in the follow-up of patients having cancer reveals a significant number of metastases, and also the great increase in the use of periodic survey films brings to light a large group of pulmonary neoplasms, a number of which turn out to be metastatic from latent primary tumors. Also a diffuse pulmonary lesion may on occasion prove to represent atypical neoplastic disease.

We have performed thoracotomies on a number of patients having metastatic disease in the lung. In an effort to define the surgical indications and to evaluate the results, we have reviewed the findings in 38 cases in which neoplastic tissue considered to be metastatic in origin (Table 1) was obtained. A number of additional cases have been excluded in which histopathologic findings were indeterminate as to primary source of the lesion, and the clinical picture was consistent with primary bronchogenic neoplasm. A review of these 38 cases has permitted the definition of the broad surgical indications discussed below, and we believe that the results justify the continued use of surgical treatment in carefully selected patients.



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