Operation or systemic therapy in case of resectable metastases?

The lungs are the most frequent target organ in the generalization of the tumor process. Isolated metastases in the lungs are detected in 6–35% of patients with malignant neoplasms. Currently, the main method of treatment of patients with isolated metastatic lung lesions in accordance with the expanded criteria of N.R. Tomford is surgical. Numerous studies have demonstrated a 5-year survival rate of 30–50% after lung metastasectomy in carefully selected patients. Despite certain criteria for selecting patients for performing metastasectomy, its effectiveness is not always convincing, since repeated development of metastases in the lungs after performing only metastasectomy occurs in 43–66% of patients. In order to increase the efficiency of control over micrometastasis, a technique of isolated lung perfusion (ILP) has been proposed, which requires further study. Currently, surgical methods of metastasectomy and ILP should be considered as part of a combined treatment with systemic chemotherapy after careful selection of patients based on an optimal set of prognostic criteria