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Surgical resection of pulmonary metastases: Benefits, indications, preoperative evaluation, and techniques

Michael T Jaklitsch, MD
Bryan M Burt, MD
James R Jett, MD
Carlos E Bravo Iniguez, MD
Section Editor
Joseph S Friedberg, MD
Deputy Editors
Kathryn A Collins, MD, PhD, FACS
Diane MF Savarese, MD


Lung metastases from a primary extrapulmonary malignancy are often a manifestation of widespread dissemination; however, some patients have no other evidence of disease [1,2]. Extensive experience with pulmonary metastasectomy in a number of different cancers has confirmed that resection can substantially prolong survival and cure some patients [3]. Based upon these observations, aggressive resection of isolated pulmonary metastases has become a widely accepted treatment for appropriately selected patients.

The benefits of metastasectomy, selection criteria, preoperative evaluation, and techniques for surgical resection are discussed here. Outcomes according to histology are discussed elsewhere, as are issues specific to resection of soft tissue sarcoma lung metastases. (See "Surgical resection of pulmonary metastases: Outcomes by histology" and "Surgical treatment and other localized therapy for metastatic soft tissue sarcoma".)

The integration of surgery into multidisciplinary therapy for patients with specific malignancies is discussed in the appropriate topic reviews.


The majority of pulmonary metastases are asymptomatic. Most are detected incidentally during the initial staging workup of a primary cancer, or from routine post-treatment surveillance radiographic studies, typically chest computed tomography (CT). Symptoms of cough, pain, or hemoptysis may be present in patients with hilar involvement, particularly when the metastases abut or invade the bronchi. Rarely, patients with peripheral metastases present with a spontaneous pneumothorax due to tumor disruption of the visceral pleura [4].


While pulmonary metastasectomy is a commonly performed operation, belief in its effectiveness is based upon registry data and surgical follow-up studies; there are no randomized trials. Until trials are completed, uncertainty will remain about the effectiveness of metastasectomy relative to other forms of treatment (eg, chemotherapy, stereotactic radiotherapy) [5]. One such trial is underway in Great Britain for patients with metastatic colorectal cancer (ie, the PulMiCC trial, NCT01106261 [6]), in which patients are randomly assigned to pulmonary metastasectomy or active monitoring.

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Literature review current through: Nov 2017. | This topic last updated: Aug 02, 2017.
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