Pulmonary Metastasectomy in the Oligometastatic Era: Evidence Gaps, Patient Selection and Parenchyma-Sparing Surgery

Lung metastases are common across solid tumors. While systemic therapy remains foundational, pulmonary metastasectomy (PM) can offer durable disease control and, in selected patients, long-term survival. Practice is heterogeneous: indications, imaging thresholds, open versus minimally invasive access, extent of resection and margin assessment, and the role of nodal evaluation vary widely by histology and center. The emergence of targeted agents, immunotherapy, and stereotactic ablative radiotherapy further shifts how local treatments complement systemic control. Clinicians need updated, pragmatic guidance on how to select patients, tailor technique to preserve parenchyma for future interventions, and integrate surgery within multidisciplinary pathways that reflect modern oncology.This Research Topic will consolidate state-of-the-art evidence and practice for PM across histologies, clarify selection criteria in the oligometastatic setting, and define technical principles that maximize completeness of resection while minimizing loss of healthy lung tissue. We aim to address when to operate—and re-operate—how to handle nodal disease, and how to integrate surgery with contemporary systemic therapy and stereotactic radiotherapy. We encourage work that characterizes tumor biology and kinetics to refine indications, and that reports outcomes beyond survival, including complications, lung function preservation, patient-reported outcomes, and time to systemic therapy (or re-challenge). Finally, we seek to advance methodology through multicenter registries, pragmatic trials, standardized datasets, and core outcome sets suitable for cross-histology synthesis. By aligning surgical detail with oncologic strategy, this Topic will help teams individualize care and generate shared standards for practice and research.We welcome Original Research, Reviews/Systematic Reviews, Methods/Technical Notes, Clinical Trials/Protocols, Brief Reports, and carefully selected Case Series. Priority themes include:• Multidisciplinary selection and timing for first and repeat PM; defining oligometastatic biology.• Imaging and intraoperative strategies for complete resection; open vs VATS/robotic approaches; parenchyma-sparing techniques (e.g., laser) and margin assessment.• Nodal evaluation (who/when/how; sampling vs systematic dissection) and prognostic weight by histology.• Histology-specific pathways (CRC, sarcoma, RCC, melanoma, gynecologic, pediatric).• Integration with targeted/immunotherapy and stereotactic radiotherapy; sequencing and endpoints.• Outcomes beyond survival: complications, lung function, PROs, and cost-effectiveness.Submissions should clearly detail selection criteria, technique, perioperative metrics, and follow-up, and are encouraged to use standardized reporting and sharable datasets.Topic Editor Paolo Scanagatta has served on advisory boards for Ambu and Johnson & Johnson (J&J), and has received sponsorship for communication activities from Ambu and Medtronic, as well as sponsorship for conference participation from Redax. All other Topic Editors declare no conflicts of interest. Topic editors: Paolo Scanagatta, Paolo Pozzi, Marco Nardini Source: https://www.frontiersin.org/research-topics/74117/pulmonary-metastasectomy-in-the-oligometastatic-era-evidence-gaps-patient-selection-and-parenchyma-sparing-surgery