{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:11:27Z","timestamp":1765458687821,"version":"3.46.0"},"reference-count":30,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The role of pulmonary metastasectomy has been increasingly questioned in the surgical community after the PulMiCC trial challenged its benefit in colorectal cancer. However, the view on pulmonary metastasectomy among people in non-surgical disciplines remains unclear. This study explored interdisciplinary attitudes toward pulmonary metastasectomy and identified the clinical expectations shaping its future role. Methods: An anonymous online survey of active board-certified physicians in oncology, urology, gynecology and dermatology was conducted (December 2024\u2013June 2025). Twenty items covered attitudes to local ablative therapy, referral criteria, preferred modalities and future relevance. Group comparisons used Pearson\u2019s \u03c72; ordinal ratings were compared by one-way ANOVA; associations were explored with Spearman\u2019s \u03c1. Results: Of 2884 contacted physicians, 165 participated (\u22485.7%), and 106 completed the questionnaire. All 106 (100%) endorsed local ablative therapy as meaningful; 92\/106 (86.8%) favored routine integration into multimodal care. Surgical metastasectomy was selected by 49\/106 (46.2%), SBRT was selected by 27\/106 (25.5%) and image-guided ablation was selected by 7\/106 (6.6%); preference for surgery differed by specialty (\u03c72(4) = 15.31, p = 0.004), while institutional availability (in-house thoracic surgery or radiation oncology) showed no association with selecting surgery or SBRT. Key referral determinants were number of lesions (105\/106; 99.1%), anatomical location (86\/106; 81.1%; p &lt; 0.02 across specialties), and lesion size (81\/106; 76.4%; p &lt; 0.05); other factors showed no consistent inter-specialty differences. The perceived usefulness of metastasectomy was high (mode 8\/10) and showed a weak, non-significant correlation with referral experience (\u03c1 = 0.172, p = 0.077). Looking ahead, 46\/106 (43.4%) anticipated a declining role of local ablative therapy with novel systemic therapies; interest in biomarker analysis from metastatic tissue compared to primary tumor tissue was very high 97\/106 (91.5%). Conclusions: Local ablative therapy, particularly pulmonary metastasectomy, continues to be viewed as an integral and trusted element of metastatic disease management across specialties. Despite limited prospective evidence, clinicians maintain strong confidence in its clinical value and foresee its evolution toward biologically and patient-tailored indications. However, the interpretation of these findings is limited by a low response rate and potential selection bias toward European, academically affiliated respondents. To our knowledge, this is the first study to systematically capture perceptions of pulmonary metastasectomy among non-surgical oncology-related specialists.<\/jats:p>","DOI":"10.3390\/cancers17243959","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:57:41Z","timestamp":1765457861000},"page":"3959","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Status of Pulmonary Metastasectomy After PuLMiCC Trial: A Survey Amongst Oncologists, Gynecologists, Urologists and Dermatologists on Medical Needs for Local Therapy"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5483-2748","authenticated-orcid":false,"given":"Daniel","family":"Baum","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Fachkrankenhaus Coswig, Neucoswiger Str. 21, D-01640 Coswig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1594-7576","authenticated-orcid":false,"given":"Markus","family":"Grafe","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fachkrankenhaus Coswig, Neucoswiger Str. 21, D-01640 Coswig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahel","family":"Decker","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fachkrankenhaus Coswig, Neucoswiger Str. 21, D-01640 Coswig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lysann","family":"Rostock","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fachkrankenhaus Coswig, Neucoswiger Str. 21, D-01640 Coswig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Friedrich","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fachkrankenhaus Coswig, Neucoswiger Str. 21, D-01640 Coswig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4839-2130","authenticated-orcid":false,"given":"Till","family":"Pl\u00f6nes","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fachkrankenhaus Coswig, Neucoswiger Str. 21, D-01640 Coswig, Germany"},{"name":"Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, D-01307 Dresden, Germany"},{"name":"National Center for Tumor Diseases (NCT\/UCC), German Cancer Research Center (DKFZ), Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Helmholtz-Zentrum Dresden\u2014Rossendorf (HZDR), D-01307 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0022-5223(97)70397-0","article-title":"Long-Term Results of Lung Metastasectomy: Prognostic Analyses Based on 5206 Cases","volume":"113","author":"Pastorino","year":"1997","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.ejso.2008.12.005","article-title":"Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial development group Pulmonary Metastasectomy in Colorectal Cancer: Time for a Trial","volume":"35","author":"Treasure","year":"2009","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S1291","DOI":"10.21037\/jtd.2017.03.175","article-title":"Pulmonary Metastasectomy: An Overview","volume":"9","author":"Petrella","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/S0003-4975(10)61278-7","article-title":"The Effect of Metastasectomy: Fact or Fiction?","volume":"30","author":"Aberg","year":"1980","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e073042","DOI":"10.1136\/bmj-2022-073042","article-title":"Removal or Ablation of Asymptomatic Lung Metastases Should Be Reconsidered","volume":"383","author":"Macbeth","year":"2023","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"ezac253","DOI":"10.1093\/ejcts\/ezac253","article-title":"Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) Randomized Controlled Trial: A Systematic Review of Published Responses","volume":"62","author":"Williams","year":"2022","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_7","first-page":"ivad002","article-title":"Metastasectomy for Colorectal Pulmonary Metastases: A Survey among Members of the European Society of Thoracic Surgeons","volume":"36","author":"Gonzalez","year":"2023","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1186\/s13063-019-3837-y","article-title":"Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): A Multicentre Randomised Clinical Trial","volume":"20","author":"Treasure","year":"2019","journal-title":"Trials"},{"key":"ref_9","unstructured":"Morton, D.L., and Yao, K. (2003). Surgical Treatment of Pulmonary Metastases. Holland-Frei Cancer Medicine, BC Decker. [6th ed.]."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S203","DOI":"10.1097\/JTO.0b013e3181dca239","article-title":"Pulmonary Metastasectomy in Colorectal Cancer: The PulMiCC Trial","volume":"5","author":"Treasure","year":"2010","journal-title":"J. Thorac. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1097\/JTO.0b013e3182641d74","article-title":"Quality of Life Evolution after Pulmonary Metastasectomy: A Prospective Study Comparing Isolated Lung Perfusion with Standard Metastasectomy","volume":"7","author":"Balduyck","year":"2012","journal-title":"J. Thorac. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1038\/s41416-020-0927-2","article-title":"The Myth of Pulmonary Metastasectomy","volume":"123","author":"Macbeth","year":"2020","journal-title":"Br. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1093\/ejcts\/ezaa405","article-title":"Report from the European Society of Thoracic Surgeons Database 2019: Current Surgical Practice and Perioperative Outcomes of Pulmonary Metastasectomy","volume":"59","author":"Gonzalez","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1097\/JTO.0b013e31818bd9da","article-title":"Pulmonary Metastasectomy: A Survey of Current Practice amongst Members of the European Society of Thoracic Surgeons","volume":"3","author":"Internullo","year":"2008","journal-title":"J. Thorac. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Petrella, F., Danuzzo, F., Sibilia, M.C., Vaquer, S., Longarini, R., Guidi, A., Raveglia, F., Libretti, L., Pirondini, E., and Cara, A. (2024). Colorectal Cancer Pulmonary Metastasectomy: When, Why and How. Cancers, 16.","DOI":"10.20944\/preprints202403.0936.v1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S0140-6736(23)01857-3","article-title":"Consolidative Use of Radiotherapy to Block (CURB) Oligoprogression\u2014Randomised Study of Standard-of-Care Systemic Therapy with or without Stereotactic Body Radiotherapy in Patients with Oligoprogressive Cancers of the Breast and Lung","volume":"403","author":"Tsai","year":"2024","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1200\/JCO.19.00201","article-title":"Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients with Oligometastatic Non\u2013Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study","volume":"37","author":"Gomez","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1093\/jnci\/djac015","article-title":"Randomized Trial of First-Line Tyrosine Kinase Inhibitor with or Without Radiotherapy for Synchronous Oligometastatic EGFR-Mutated Non-Small Cell Lung Cancer","volume":"115","author":"Wang","year":"2023","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1097\/JS9.0000000000000339","article-title":"Role of Local Ablative Treatment in Oligometastatic Non-Small Cell Lung Cancer: A Meta-Analysis","volume":"109","author":"Rim","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"FSO471","DOI":"10.2144\/fsoa-2019-0120","article-title":"Surgery Versus Stereotactic Radiotherapy for Treatment of Pulmonary Metastases. A Systematic Review of Literature","volume":"6","author":"Londero","year":"2020","journal-title":"Future Sci. OA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1097\/JTO.0b013e3181de7143","article-title":"Stereotactic Radiotherapy for Pulmonary Oligometastases: A Systematic Review","volume":"5","author":"Siva","year":"2010","journal-title":"J. Thorac. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.lungcan.2016.04.012","article-title":"Stereotactic Body Radiotherapy (SBRT) for Medically Inoperable Lung Metastases\u2014A Pooled Analysis of the German Working Group \u201cStereotactic Radiotherapy\u201d","volume":"97","author":"Rieber","year":"2016","journal-title":"Lung Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Shirai, K., Endo, M., Aoki, S., Kishi, N., Fukuda, Y., Nonaka, T., and Ishikawa, H. (2025). Efficacy of Radiotherapy for Oligometastatic Lung Cancer and Irradiation Methods Based on Metastatic Site. Cancers, 17.","DOI":"10.3390\/cancers17152569"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Welter, S., Moneke, I., Wara, R., Le, A.U.-T., Shalabi, A., Graeter, T., Ploenes, T., and Baum, D. (2025). Pulmonary Metastasectomy: A Multicenter Comparison of Wedge Resection Versus Anatomic Resection for Single Metastases of Colorectal Cancer. Cancers, 17.","DOI":"10.3390\/cancers17203299"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ejcts.2006.11.004","article-title":"Prognostic Impact of Lymph Node Involvement in Pulmonary Metastases from Colorectal Cancer","volume":"31","author":"Welter","year":"2007","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Baum, D., Rolle, A., Koschel, D., Rostock, L., Decker, R., Sombati, M., \u00d6hme, F., and Pl\u00f6nes, T. (2024). Long-Term Follow-Up after Laser-Assisted Pulmonary Metastasectomy Shows Complete Lung Function Recovery. Cancers, 16.","DOI":"10.3390\/cancers16091762"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1016\/S0140-6736(18)32487-5","article-title":"Stereotactic Ablative Radiotherapy versus Standard of Care Palliative Treatment in Patients with Oligometastatic Cancers (SABR-COMET): A Randomised, Phase 2, Open-Label Trial","volume":"393","author":"Palma","year":"2019","journal-title":"Lancet Lond. Engl."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/0163278713496426","article-title":"Facilitators and Barriers to Survey Participation by Physicians: A Call to Action for Researchers","volume":"36","author":"Klabunde","year":"2013","journal-title":"Eval. Health Prof."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"De Felice, F., Malerba, S., Nardone, V., Salvestrini, V., Calomino, N., Testini, M., Boccardi, V., Desideri, I., Gentili, C., and De Luca, R. (2025). Progress and Challenges in Integrating Nutritional Care into Oncology Practice: Results from a National Survey on Behalf of the NutriOnc Research Group. Nutrients, 17.","DOI":"10.3390\/nu17010188"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e6318","DOI":"10.2196\/jmir.6318","article-title":"Incentive and Reminder Strategies to Improve Response Rate for Internet-Based Physician Surveys: A Randomized Experiment","volume":"18","author":"Cook","year":"2016","journal-title":"J. Med. Internet Res."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/24\/3959\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:04:24Z","timestamp":1765458264000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/24\/3959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":30,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["cancers17243959"],"URL":"https:\/\/doi.org\/10.3390\/cancers17243959","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}