Minimally invasive metastasectomy for skin and soft tissue malignancies: sarcomas, melanoma, and breast cancer: a narrative review

Background and Objective: Pulmonary metastasectomy (PM) is a thoracic surgery operation in which metastatic disease is surgically resected from the lung. Traditionally, PM has been performed via thoracotomy, to allow surgeons to manually palpate the lung and detect additional disease not detected on preoperative imaging. However, the contemporary widespread use of minimally invasive thoracic surgery raises additional questions about the suitability of a minimally invasive approach. In this narrative review, we cover the relevant considerations of minimally invasive PM for soft tissue sarcoma, breast cancer, and melanoma.Methods: A literature review was conducted using the PubMed/MEDLINE database including all relevant articles through March 2023. Articles were reviewed for relevance by the authors. There were no restrictions on type of study included.Key Content and Findings: Preoperative, intraoperative, and postoperative considerations for a minimally invasive approach to PM for soft tissue sarcoma, breast cancer, and melanoma are summarized in this review. Wedge resection was the most common type of resection for all three malignancies. The role of lymph node dissection or sampling remains controversial and underreported in the literature. No studies were identified that demonstrated inferior overall survival or disease-free survival with minimally invasive PM for these malignancies.Conclusions: For soft tissue sarcoma, breast cancer, and melanoma, a minimally invasive approach to PM is likely appropriate for select patients. Studies focusing on PM in the setting of breast cancer and melanoma are particularly limited and additional reports would be of great benefit to the literature.