Systematic Review of Outcomes and Prognostic Factors of Pulmonary Metastasectomy for Various Primary Tumors

Pulmonary metastasectomy (PM) is a surgical procedure to remove lung metastases. Although it indicates advanced-stage disease, it is considered a therapeutic option to prolong survival in selected patients with oligometastatic disease, where lesions can be controlled locally. This systematic review synthesized the available evidence from reviews and retrospective studies on survival outcomes and prognostic factors associated with pulmonary metastasectomy (PM). A literature search was conducted in Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials covering the last 30 years up to January 2025, using the term "pulmonary metastasectomy." Studies involving human subjects and published in English were included. Eighty two articles were reviewed. PM offers significant survival benefits across various tumor types, with 5-year survival rates varying widely (e.g., 35% to 72% for breast cancer and 40% to over 70% for colorectal cancer). Key favorable prognostic factors include: control of the primary tumor, absence or control of extrapulmonary metastases, complete resectability (R0), a long disease-free interval (DFI), and a limited number or size of metastases. However, most data comes from retrospective studies with potential selection bias. PM is considered a valid and potentially curative component of multimodal treatment strategies for resectable lung metastases. It requires rigorous patient selection and a multidisciplinary approach. Current limitations of the evidence (lack of randomized controlled trials, selection bias, high recurrence rates) highlight the need for further prospective research to optimize selection criteria and integrate PM with emerging systemic therapies.