From the Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, 530 First Avenue, Suite 9V, New York, NY
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Harvey I. Pass MD, Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, 530 First Avenue, Suite 9V, New York, NY 10016, 212-263-7417, 212-264-5950; e-mail: Harvey.pass{at}med.nyu.edu
Overview: The treatment of a patient with isolated metastases from sarcoma to the lung remains controversial. It is reasonable to consider resectional therapy for disease that fails to respond to systemic therapy or for patients with no other treatment options who have, in the opinion of a thoracic surgical oncologist, "completely resectable disease." Patients who benefit the most are those who have a long disease-free interval from their original resection of the sarcoma, as well as patients who have a long doubling time. Patients who have a small number of metastases will benefit more than those with a large disease burden. Careful preoperative work-up must determine if the patient has miliary disease before resection to avoid futile thoracotomy. Approaches for surgery include open lateral thoracotomy, median sternotomy, and video-assisted techniques. Whatever technique is used, a complete resection must be performed or there will be no benefit of the procedure. The use of adjuvant therapy after such a complete resection also remains controversial.
