Video-assisted thoracic surgery (VATS) and radiofrequency ablation (RFA) are increasingly being used in the treatment of primary and secondary pulmonary malignancies. Although thoracotomy remains the standard of care for the treatment of the patient with limited metastastic disease to the lung, VATS and RFA may be appropriate in the treatment of selected patients. The number and location of metastases within the lung influence the use of either VATS or RFA. In this article, the authors, based on a review of literature and personal experience, make recommendations for the incorporation of these modalities into the care of patients requiring pulmonary metastasectomy.