Resection of pulmonary metastases: a growth industry

Surgical metastasectomy is increasing both in the numbers of operations performed and the extensiveness of surgery that is being undertaken. Radiologists play a central role in this work. It is they who first detect metastases on cancer staging scans and it is they who detect recurrence of cancer on surveillance scans performed in the course of follow-up. Radiologists then play a key role in characterising and diagnosing any lung nodules thus discovered. For colorectal and lung cancer the clinical teams are typically quite separate, but radiologists have a role in both multidisciplinary team meetings. Thus it may well be that the radiologist is party to discussions about the same patient and the same imaging information in quite separate multidisciplinary team meetings and needs to understand the imaging needs and clinical objectives of both. As surgery is becoming more extensive, the inescapable harm done as a consequence of lung resection is increasing. Good quality evidence for benefit is lacking. The purpose of this article is to provide an update on the practice of metastasectomy, the selection of patients, the objectives of surgery, and uncertainties about its effectiveness.