A retrospective analysis was performed to determine the prognostic factors affecting survival in children who underwent pulmonary metastatectomy. Seventeen patients who underwent pulmonary metastatectomy between 2000-2006 were evaluated retrospectively by means of age, sex, primary diagnosis, time of metastasis appearance, number of nodules found on imaging examinations, type of management, surgical data, and outcome. Video-assisted thoracoscopic surgery (VATS) was used in 11 patients, and all patients underwent thoracotomy consequently. The nodule was composed of tumor cells in 13 (76%) patients and had positive surgical margins in 5 (38%). The time of metastasis appearance, number of metastases and completeness of the nodule excision did not affect survival (p=0.31, p=0.87 and p=0.56, respectively). Nodule size >1 cm was associated with dismal survival (p=0.008). Time elapsed until the diagnosis of pulmonary metastasis, number of metastases and the completeness of metastatectomy do not have an impact on survival. The only significant prognostic factor is the size of the largest metastatic nodule. The presence of a metastatic nodule >1 cm is associated with a worse outcome in pediatric patients. VATS is an adjunct method to thoracotomy in the surgical management of pulmonary metastasis in children.