metastasectomy

Metastasectomy is the surgical removal of metastatic cancer deposits with the aim of eradicating detectable disease, extending survival, or alleviating symptoms. It is distinct from resection of the primary tumor and is most often considered in cancers with limited, resectable metastatic burden in a suitable patient.

Indications for metastasectomy include oligometastatic disease where complete resection is technically feasible and the primary tumor is controlled, the patient has adequate performance status and organ function, and there is no widespread or untreated systemic disease. Commonly treated sites are the liver and lungs, particularly in colorectal cancer with limited liver metastases, renal cell carcinoma, and certain sarcomas. Metastasectomy may also be considered in selected cases of peritoneal metastases, bone metastases, or nodal metastases. In addition to potential curative intent, the procedure can provide palliation by preventing symptoms such as pain, bleeding, or obstruction.

Procedures vary by site and may include open or minimally invasive (laparoscopic or thoracoscopic) resections. In peritoneal metastases, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is performed in specialized centers. Outcomes are highly dependent on cancer type, extent of disease, and completeness of resection (R0 or R1). Selected patients can achieve meaningful long-term survival; others face recurrence.

Risks align with major abdominal or thoracic surgery and include bleeding, infection, organ dysfunction, and specific site-related complications. Metastasectomy is generally pursued within a multidisciplinary framework, balancing potential benefits against surgical risk and available systemic therapies.