Metastasis

Contraindication

Surgery

Metastasectomy

Lung cancer

Pulmonary function testing

Radiology

Alternative medicine

Dissection (medical)

Political science

Thoracotomy

Internal medicine

MEDLINE

Medicine

Cancer

Pneumonectomy

Pathology

The Annals of Thoracic Surgery

Dr Fernando discloses a financial relationship with Galil Medical. Dr Fernando discloses a financial relationship with Galil Medical. 1.When caring for patients with cancer and pulmonary oligometastases, pulmonary metastasectomy (PM) should be considered within a multidisciplinary team (MDT) and carefully individualized.2.In oncologically and medically appropriate non-small cell lung cancer (NSCLC) patients, tissue from PM should be sent for genomic/molecular analysis, including programmed death-ligand 1, to guide future therapies.3.In oncologically and medically appropriate patients, PM can be considered with a preference for minimally invasive surgery (MIS) because of shortened postoperative recovery and lessened effect on quality of life.4.If goals of R0 and pulmonary parenchymal sparing are not accomplishable by MIS but lend themselves to open approaches (thoracotomy, sternotomy, or clam shell), open techniques are appropriate.5.Pneumonectomy to accomplish PM is discouraged except in carefully selected patients undergoing MDT management.6.Although the absolute number of pulmonary metastases is not a direct contraindication to PM, candidate selection for PM is best suited to patients harboring 3 or fewer pulmonary metastases.7.Lymph node (LN) sampling/dissection concomitant with PM should be considered, because pulmonary metastasis accompanied by mediastinal LN metastasis predicts poor survival.8.Thermal ablation or stereotactic ablative body radiotherapy (SABR) is reasonable therapy for patients with pulmonary oligometastases, particularly for patients considered high risk for resection or who refuse resection.9.Outside of clinical research, isolated lung perfusion is not warranted for management of pulmonary metastases.10.In colorectal cancer patients, PM can be considered within an MDT construct with systemic therapy before or after PM.11.In renal cell carcinoma patients, PM can be considered within an MDT construct.12.In malignant melanoma patients, PM can be considered within an MDT construct.13.In sarcoma patients, PM can be considered within an MDT construct.14.PM in management of primary head and neck cancer can be considered in the context of a disease-free interval (DFI) exceeding 12 months, ability to completely resection, and absence of LN metastases.15.When managing nonseminomatous germ cell tumors (NSGCTs), PM is indicated for all residual lung abnormalities ≥ 10 mm after platin-based chemotherapy with normalized serum tumor markers (STMs) suspected of containing teratoma.16.When managing NSCGTs, contralateral lung abnormalities can be observed if histology of unilateral PM demonstrates complete tumor necrosis.17.When managing NSGCTs, PM is indicated for select patients with limited number of lung abnormalities after first-line or second-line platin-based chemotherapy suspected of containing viable nonseminomatous cancer or malignant transformation of teratoma into non-germ cell cancer, or both.18.In breast cancer patients, PM can be considered within an MDT construct.

Expert Consensus Document on Pulmonary Metastasectomy