Why choosing a video-assisted thoracic surgery approach for pulmonary metastasectomy?

Traditionally, the main objective of lung metastasectomy has been to confirm the metastatic nature of the disease and to achieve complete resection of all detectable lesions through thoracotomy accompanied by bimanual palpation. During the past two decades, advances in radiological imaging and in minimally invasive surgery have changed this paradigm and shifted practice to less invasive video-assisted thoracic surgery (VATS)-mediated approaches, whenever possible. However, pulmonary metastases (PMs) may have various origins, histological characteristics, numbers or size. Furthermore, oncological outcomes must be the ultimate end-point of any procedure, and no perceived benefit of VATS may jeopardize them. The aim of this review is to focus on recent advances in VATS pulmonary metastasectomy.