Pulmonary metastases are considered for surgical resection in medically fit patients only if which criteria are met?

• A. Primary tumor must be controlled or imminently controllable; no other sites of disease may exist; no other therapy can offer comparable results; operative risk must be low
• B. Primary tumor must be uncontrolled; any metastatic pattern is acceptable; operative risk is not a concern; patient preference dictates surgery
• C. All metastases must be subcentimeter in size; patient must be under age 60; no prior chemotherapy
• D. There must be widespread disease with multiple extra-thoracic metastases; surgery is considered if the patient tolerates anesthesia

Answer: (A)

Pulmonary metastasectomy is considered only in patients who have a limited metastatic burden and for whom surgery could offer cure or meaningful control. The essential requirements are that the primary cancer is controlled or controllable, there are no other disease sites that would preclude complete removal, no alternative nonoperative therapy is expected to yield better results, and the patient is fit enough to tolerate the operation with low risk. This combination maximizes the chance of achieving complete resection with acceptable morbidity and ensures that removing the lung metastases can meaningfully impact outcomes. Scenarios where the primary is uncontrolled, widespread or unfavorably distributed metastases exist, operative risk is high, or decisions are driven by preference without regard to disease biology do not meet these criteria.