This surgical technique consists of complete surgical excision with a clear margin often utilising modern minimally invasive techniques with preservation of as much pulmonary parenchyma as possible. This awaits scrutiny with randomised prospective trials but is supported by many sizeable retrospective surgical series worldwide.

We report our own series of nearly 200 cases over the last 10 years. The majority pathological conditions are metastatic Colorectal Cancer and Melanoma was well as a broad spectrum of other solid and soft tissue tumours. This caseload is increasing - 25 cases were performed in the last 6 months. The overwhelming majority of cases are performed thoracoscopically with an avoidance of rib-spreading. Improved visualisation, imaging techniques and more robust surgical stapling devices have lead to significant surgical achievement with less hospital stay and patient morbidity. Potentially this has lead to increased utilization without necessarily increasing the disease-free interval or prolongation of life.

Significant challenges require answers in this clinical domain: the definition of Oligometastatic disease, the role of anatomical and function imaging, the extent of radical surgery - when do the risks outweigh the benefits - and lastly how to best understand the natural history of the malignant process especially when modified by an ever growing armoury of effective chemotherapeutic agents.