The management of the advanced colorectal cancer: management of the pulmonary metastases

摘要: Pulmonary metastases from colorectal cancer present as systemic manifestation of the disease. As a general principle, presence predispose to poor prognosis. However, application some criteria “operability” permitted surgical resection resulting in prolonged survival (reported 5-year up 50%), better quality life and cure patients. When primary tumor site is controlled, metastatic disease limited lungs without extrapulmonary location (except for resectable or resected hepatic lesion) removal indicated. significant prognostic factors metastasectomies have been reported synchronous metachronous caracter metastases, free survival, complete thoracic lymph node invasion, CEA level before metastasectomy 1 month after, solitary vs. multiple pulmonary locations, induction chemotherapy, histological type differentiation grade, well vascular emboli histopathological examination. Thorough preoperative evaluation patient includes oncological assessment respiratory functional tests. Alternatively, when not good candidate, radiofrequency ablation an option. Many accesses validated, posterolateral lateral even posterior thoracotomy, sternotomy, clamshell incision, thoracoscopic techniques that offer advantages less pain, fast recovery, morbidity. Though questioned concerning completeness removal, no statistical difference has revealed many series comparing thoracotomy techniques. conclusion, there are advances management during last decade, results essentially optimized, role surgery established, multimodality approach recognized cornerstone successful outcome.