# From Feasibility to Individualization: Surgery for Breast Cancer Liver and Lung Metastases

## TL;DR

This review explores how surgery for breast cancer liver and lung metastases is becoming a personalized treatment option for select patients, supported by emerging technologies and improved outcomes.

## Contribution

The paper highlights the shift toward individualized surgical strategies for oligometastatic breast cancer, integrating modern tools like AI and molecular testing.

## Key findings

- Liver metastasectomy can achieve 5-year survival rates of up to 60% in well-selected patients.
- Pulmonary metastasectomy shows comparable outcomes when resection is complete and nodal involvement is absent.
- Emerging tools like circulating tumor DNA and AI are helping refine surgical decision-making.

## Abstract

Breast cancer can spread to distant organs, such as the liver and lungs. Traditionally, when this happens, treatment has focused mainly on medications rather than surgery, because metastatic disease has been considered systemic and incurable. However, in selected patients with a limited number of metastases, surgical removal of these lesions is increasingly being explored as part of a personalized treatment strategy. This review summarizes current evidence on surgery for liver and lung metastases from breast cancer, discussing which patients may benefit, how outcomes compare with non-surgical approaches, and how modern tools such as molecular testing and artificial intelligence may improve decision-making. While promising results have been reported in carefully selected patients, strong randomized evidence is still lacking. Future research is needed to clarify when surgery meaningfully improves long-term outcomes.

Surgical resection of liver and lung metastases in breast cancer is increasingly considered a viable option for select patients with oligometastatic disease. Historically regarded as palliative, surgery is now supported by retrospective data suggesting potential survival benefits, particularly in patients with hormone receptor-positive or HER2-positive tumors, long disease-free intervals, and limited metastatic burden. This narrative review summarizes recent evidence on the surgical management of breast cancer metastases to the liver and lung, with a focus on patient selection, perioperative outcomes, and long-term survival. Liver metastasectomy has shown 5-year overall survival rates of up to 60% in well-selected patients, while pulmonary metastasectomy is associated with comparable outcomes when resection is complete and nodal involvement is absent. Minimally invasive techniques and non-surgical approaches, such as microwave ablation and stereotactic radiotherapy, expand treatment options for patients unfit for surgery. The review also explores emerging tools influencing surgical decision-making, including circulating tumor DNA for minimal residual disease detection, transcriptomic profiling to predict organotropism, and artificial intelligence (AI)-driven platforms that assist with surgical planning and multidisciplinary case evaluation. While prospective validation remains limited, these technologies may help redefine surgical candidacy through biologically informed algorithms. Ultimately, the integration of surgery within a multimodal, personalized treatment strategy—guided by systemic control, tumor biology, and evolving digital tools—represents an evolving and biologically informed direction for rigorously selected patients with visceral breast cancer metastases.