Skip to Main Content


The recognition of pulmonary metastases from an extrathoracic primary tumor is a dramatic and emotional change in the care of the cancer patient. The clinical situation immediately changes from potential cure to the tacit acknowledgment of probable incurability. Goals of therapy change from living without evidence of disease to living, and living well, with systemic disease. We believe that pulmonary metastasectomy in carefully selected patients contributes to quality of life and may give the patient extended periods of time without obvious disease.


Many primary tumors metastasize to specific target organs.1 In the 1930s, it was noted that patients dying of pulmonary metastases frequently failed to exhibit extrapulmonary disease at autopsy.2 As a result, several surgeons felt that it would be reasonable to offer surgical resection of these lesions in the hope of prolonging survival. The first reported pulmonary metastasectomy removed a single renal cell metastasis in 1930, and the patient lived for two more decades.3 Interest in this surgical approach was increased with the development of systemic adjuvant chemotherapy, which appeared to increase survival.


The role of surgical resection of metastatic disease, however, is not universally accepted in the nonsurgical community. No randomized trial has been constructed to establish a survival advantage of pulmonary metastasectomy. In fact, the multitude of variables that would have to be included in the eligibility criteria (e.g., number of metastases, cell type, disease-free interval, cardiorespiratory reserve, etc.) makes it unlikely that a randomized trial of this nature will ever be performed. Without such data, however, some authors remain skeptical that surgical resection adds significant benefit.4,5 Opponents to this approach point out that larger trials claiming improved survival after metastasectomy have been conducted in heterogeneous populations with tumors of mixed histologic types and mixed doubling times. The patients who benefit the most from surgical resection have a small tumor burden and a long doubling time (disease-free interval), and this group may be able to live a long time with their disease even without surgical resection. The skeptics argue that a hypothetical study population that included slow-growing tumors in 40% of the subjects would produce a 30% 5-year survival after surgery, and that same 30% also would still be alive without an operation.


These arguments highlight the heterogeneity of this patient population and emphasize the need to tailor the surgical approach to each individual patient. Patients with dozens of metastases or rapid recurrence after a previous pulmonary metastasectomy will not gain major benefit from surgery. A very elderly patient with a slow-growing metastasis that would require pneumonectomy for resection might be better treated in other ways. These exceptions still leave many patients with pulmonary metastases that can be removed safely with an anticipated low morbidity and mortality.6


A large volume of retrospective data is available to substantiate a significant long-term survival with pulmonary metastasectomy. When these data are compared with those of patients with pulmonary ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.