Role of Surgery in Oligometastatic Disease

Solitary and oligometastatic lesions occur in a subset of patients afflicted by bone metastases. Oligometastases are a distinct spectrum of disease for which aggressive surgical management may prolong survival or even potentiate cure. Basic research and empiric clinical evidence suggest that some cancers are biologically restricted in the capacity for distant spread. Renal cell carcinoma and thyroid cancer have been most frequently reported to benefit from aggressive surgical treatment of bone oligometastases. Complete surgical resection of solitary and oligometastases has been associated with improved survival in numerous retrospective studies. Advances in cancer screening, diagnostics, and medical treatment will likely render more patients amenable to curative intent treatment of metastases. Since the first edition, multiple prospective trials have been published supporting the use of stereotactic ablative radiotherapy techniques for the treatment of oligometastases. Minimally invasive ablation techniques including cryoablation, radiofrequency ablation, irreversible electroporation, and microwave ablation have also been utilized for the definitive local control of bone metastases with promising results in retrospective studies. Surgeons should consider whether metastatic bone disease patients may be treated with curative or at least life-prolonging intent before proceeding to purely palliative strategies.