Thoracic surgeons have been reluctant to adopt the median sternotomy as a suitable approach to pulmonary operations. However, its lesser functional morbidity and the capability to assess both lungs are advantageous in selected patients. Examined herein is a concentrated experience with 53 median sternotomies in 46 patients for the resection of pulmonary metastases. Forty of the 46 patients had soft tissue or osteogenic sarcoma. Full-lung tomograms diagnosed but did not accurately reflect the extent of disease. Fifty-three percent more tumor nodules were found at median sternotomy than were seen on full-lung tomography. Eleven of 18 patients (61%) thought to have unilateral disease by full-lung tomography had bilateral metastases found at median sternotomy. Most median sternotomies involved wedge resections (mean 8.9 range one to 52). Two segmentectomies, six lobectomies, and one pneumonectomy were also performed. Repeat median sternotomy was accomplished seven times; one patient underwent four median sternotomies. Sixty-six percent of the nodules removed proved to be tumor. Complications included one reoperation for bleeding; three patients had air leaks for more than 1 week, including one bronchopleural fistula; four required respirator assistance for more than 3 days; and there were four major infections. There was no operative mortality. Because of its low morbidity, the high incidence of unsuspected bilateral disease, and the elimination of a second operative procedure, median sternotomy is the approach of choice for the surgical treatment of pulmonary metastases.