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T7. IS SURGERY FOR MULTIPLE LUNG METASTASES REASONABLE?
(328 CONSECUTIVE CASES OF MULTIPLE LASER METASTASECTOMIES WITH A NEW 1318 NM ND:YAG LASER)
Axel Rolle, Arpad Pereszlenyi, Rainer Koch, Alfred Richard, Barbara Baier; CoswigDresden, Germany

OBJECTIVE: is to review a single institutional experience with management of multiple lung metastases and to define the role of a new 1318 nm Nd: YAG laser in a surgery for lung metastases.
PATIENTS AND METHODS: Between 1/96 and 12/2002 in 328 patients 2296 metastasectomies (7 per patient, ranged 1 to 124) were performed using our new laser system. There were 157 males and 171 females in the age range from 20 to 81 yr (mean 60.7 yr). In all patients lung-parenchyma-saving resection (LPR) by a 1318-nm wavelength Nd:YAG laser was performed. The main indications for laser LPR (LLPR) included lung metastases of following primaries: renal carcinoma in 93 cases, colorectal in 88 and breast cancer in 33 cases. In the remaining 114 cases LLPR was performed for metastases of bronchogenic carcinoma (n=22), malignant melanoma (n=18), sarcomas (n=17), head and neck carcinoma (n=20) and for mts of other less frequent ones (n=37). In all patients the R0 resection was achieved.
RESULTS: There was no perioperative mortality. Postoperative complications included prolonged air-leak in 2 and intrathoracic (intraparenchymal) bleeding in further 2 cases. All these complications were successfully overcomed by conservative manners, without necessity of rethoracotomy. Follow-up was completed for all pts and it ranged from 1 to 198 Mo (median 31). Overall survival for complete curative LLPR was 84% at 1 yr, 55% at 3 yrs and 38% at 5 yrs.
CONCLUSION: Multiple lung metastases present a serious and challenging problem with increasing incidence for thoracic surgeons. In lung metastasis management a significant role belongs to LLPR. This new laser system expands the scope of surgical treatment for multiple pulmonary metastases, allowing more complete resection with higher number of nodules with comparable results reported after solitary metastasectomy.

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