Keyword: Metastatic Cancer

ABSTRACT: Surgery in metastatic cancer has been considered to have a limited role in the treatment of metastatic disease and has generally been reserved for palliative intent. However, as imaging, systemic therapy, surgical techniques, and understanding of the biology of cancer has improved, the role of surgery in the treatment of metastatic disease has evolved. This narrative review will discuss the current state of surgical therapy in metastatic cancer and the indications for such an approach. A discussion of the impact of reducing tumor burden, the concept of oligometastatic disease, and the role of host–tumor interactions will provide a basis for the discussion. The objectives of surgery have evolved from palliation to include longer survival and even potentially curative intent. The primary consideration in the decision to pursue surgical therapy for metastatic disease is proper patient selection, and this requires a thorough evaluation of disease and patient factors, as well as the integration of systemic therapy and other local therapies. While evidence is strongest for metastasectomy in colorectal cancer, there is growing evidence in breast cancer, renal cell carcinoma, lung cancer, and neuroendocrine tumors. As a general rule, the optimal management of metastatic cancer includes a combination of systemic and surgical therapies to maximize benefit for the patient. While there are limitations to the current role of surgical therapy in metastatic cancer, challenges including surgical morbidity, delays in initiation of necessary systemic therapy, and a paucity of high-quality evidence, proper patient selection remains the cornerstone to providing meaningful clinical benefit.