[The surgeon and the metastatic disease]

For a long time, metastatic disease was a prohibited zone for surgeons locked into their roles in controlling primary non-disseminated tumours. However, this has changed at the end of the 20th century with the apparition of effective chemotherapies and targeted therapies. Since then, surgeons have been able to treat hepatic, pulmonary, peritoneal and brain metastases. The more chemotherapy progresses and controls disease, the more surgeons can operate on residual disease. With this final surgery acting on the defined perimeter of systemic treatment efficacy, it appears to offer gains in progression-free survival. Gains in overall survival have not yet been demonstrated. Further, new technologies should enable surgeons to reduce the lower limits of their fields of action, increasing their therapeutic perimeters. Metastatic disease constitutes a unique model of therapeutic synergy that can be accredited to multidisciplinary strategy.