Narrative review on minimally invasive metastasectomy for head and neck malignancies

Background and Objective: Head and neck cancer (HNC) is the 7th most common malignancy globally, with the lungs being the most common site of distant metastases. Pulmonary metastasectomy (PM) has traditionally been performed using open techniques. Since the advent of thoracoscopy, these procedures have increasingly been performed using minimally invasive techniques. We review available evidence on outcomes of PM for HNC, with a focus on minimally invasive PM. Methods: A PubMed search was performed using the search combination: metastasectomy, metastases, head cancer, head carcinoma, neck cancer, and neck carcinoma. All relevant articles published between the years 2000 and 2023 were identified. Case reports, reviews, and articles lacking relevance to the study were excluded. A total of 15 original articles were selected for this narrative review. Key Content and Findings: PM for HNC confers a survival benefit when compared to non-surgical treatment in carefully selected patients. The favorable prognostic factors for PM include a disease-free interval (DFI) >12 months, female sex, non-squamous cell cancer (SCC) histology, younger age, R0 resection, and an extra-oral site for the primary HNC. Currently, minimally invasive options for PM seem to be associated with superior short and similar long-term outcomes to thoracotomy. Conclusions: PM is associated with favorable survival outcomes for metastatic HNC when compared to non-operative therapy. Minimally invasive PM seems to be a safe and feasible option for PM with superior short and similar long-term outcomes to conventional open PM.