Open Surgical Approaches for Pulmonary Metastasectomy

Surgeons differ in the approach to resection of pulmonary metastases from nonpulmonary primary malignancies, with some favoring procedures that minimize trauma to the patient, and others performing open procedures with the goal of maximizing likelihood of resection of all detectable sites of disease. This article reviews how pulmonary metastasectomy emerged as a therapy for metastatic disease. Discussed is how surgical approaches used for this procedure have evolved, the available literature addressing whether open procedures lead to more complete resections, and if so whether resection by open procedures increases the likelihood of cure following resection. The technical aspects of the various thoracotomy techniques are also reviewed.