Almost 125 years after the first documented case, pulmonary metastasectomy is still poorly understood. No other organ is subject to the wide histologic variety of metastatic insults, and this fact has complicated a complete exposition of when pulmonary metastasectomy may be beneficial. Many physicians still consider pulmonary metastatic disease to be always incurable, and they may underestimate existing surgical options including the benefits of pulmonary metastasectomy. In addition, technological improvements in radiological screening of pulmonary metastases and thoracoscopic resection are fundamentally altering the management of these patients and their surgery. This article reviews the history, form, and future of pulmonary metastasectomy, the literature that supports or refutes its application in various tumor types, and the screening and surgical evaluation that is needed prior to its performance.