Pneumonectomy for lung metastases: the role in the modern era
Lung metastasectomy is considered worldwide as part of multimodal treatment for selected oligometastatic patients. Wedge resection is the most common approach performed with lung-sparing intent and, even if anatomical resections like segmentectomies or even lobectomies can be accepted, the role of pneumonectomy has always been debated and progressively discouraged due to the perceived high morbidity and mortality rates compared with its uncertain oncological benefits. A retrospective review and analysis of patients underwent pneumonectomy for lung metastases conducted in our center from January 1995 to December 2017 showed that on a total of 832 pneumonectomies performed, only 17 (2%) were conducted to resect pulmonary metastases and above all, only two patients were operated in the last decade. This revealed the tendency to progressively abandon the use of pneumonectomy to treat pulmonary metastasis. Indications and outcomes of pneumonectomy to resect pulmonary metastases are illustrated along with the speculative reasons of the decrease in the use of this therapeutic tool. The latter include a better patient selection due to the improved understanding of the oligometastatic disease, major improvements in the efficiency and tolerance of systemic therapies and the availability of alternative techniques for the local treatment of secondary lung lesions. Nevertheless, the limited benefit in terms of long-term survival and the relative high morbidity and mortality should not exclude a priori from considering pneumonectomy with curative intent for locally-advanced metastatic disease. A tiny role for this option is likely to remain in the therapeutic armamentarium for highly selected patients with isolated resectable pulmonary metastases undergoing a multidisciplinary management when no other alternatives are available.