Two hundred and sixty-one patients underwent a total of 295 operations for pulmonary metastases between 1972 and 1984. Some characteristics are essential for the surgical strategy of operations on pulmonary metastases: Upon thoracotomy about 40% of the patients show more uni- or bilateral metastases than expected after the most careful preoperative diagnostic examinations. Approximately 25% of the patients exhibit preoperatively undiagnosed metastases on the contralateral side. Bilateral consecutive thoracotomy is associated with the risk of secondary inoperability. The median thoracotomy takes these characteristics more into consideration than all other routes as both pleural cavities, lung and mediastinum can be explored and treated at the same time. The necessary prerequisites for radical resections are obtained only in this way and potential cure should always be the aim of surgery for metastases. Simultaneous bilateral pulmonary resections require careful postoperative intensive care. The advantage for the patient is a one-stage operation and thus less subjective stress, a much shorter hospitalization and the chance to start necessary postoperative chemotherapy as soon as possible. The median thoracotomy allows all standard resection techniques. With 66%, the atypical and segmental resections were the techniques mainly used. The overall mortality was 3.3%.