Pulmonary metastasectomy: common practice but is it also best practice?

Pulmonary metastasectomy is common practice among surgeons, comprising nearly 15% of all lung resections. Pulmonary metastasectomy from a primary tumor elsewhere is widely believed to improve survival in selected patients, although the evidence for the added value of surgery is still weak. Most resections are performed in patients with a long disease-free interval with few metastases limited to one or both lungs from all cancer types. Until results of a randomized trial comparing surgery versus no surgery, such as in patients with colorectal metastases (PulMiCC trial), are published, surgeons will be unable to give an evidence-based answer to patients asking for the benefit of this invasive treatment that jeopardizes their pulmonary function, exercise capacity and quality of life.