This article provides information about lung metastasis, why surgery is necessary, and international recommendations. You will find detailed insights into the diagnosis, treatment, surgical methods, risks of lung metastasis, hospital stay duration post-surgery, and the process of chemotherapy or radiotherapy after the surgery.
Lung Metastasis Surgery and Treatment
Cancer from another organ can spread to the lungs, known as metastasis. In such cases, chemotherapy is typically the treatment method. However, in some instances, metastases in the lung can be surgically removed.
A lung metastasis is treated based on the following factors:
- Location of the metastatic mass
- Number of metastases (single, double, or multiple)
- General health condition of the patient
- Whether the primary tumor (e.g., colon cancer) has been treated
The image shows a lung metastasis in the left lung of a 39-year-old female patient three years after the treatment of malignant melanoma.
Why Is Metastasis Surgery Necessary?
Surgery is always the first option for treating lung metastases as complete removal of metastatic masses often results in a full cure. The decision to proceed with surgery should be made collectively by oncology, pulmonology, and thoracic surgery specialists. If surgery is determined to be the best method for treating the patient, it is performed. Surgery is avoided if it is unlikely to positively impact the patient’s health.
Which Patients with Lung Metastasis Qualify for Surgery?
- The primary cancer must have been fully treated (via surgery, medication, or radiotherapy). The treating physician should confirm that the primary cancer is no longer present (e.g., a patient who underwent surgery and chemotherapy for breast cancer).
- There should be no metastasis in any part of the body outside the lungs.
- The patient’s respiratory functions should be adequate for surgery.
- There should be enough healthy lung tissue left after removing the metastases to support normal life.
Additional factors influencing the decision include the type of tumor, the time elapsed between the initial cancer diagnosis and the appearance of metastases, and the patient’s overall health condition.
What Do International Guidelines Recommend for Lung Metastasis?
Surgical removal of lung metastases, whenever possible, is recommended by all international sources. Studies show that disease-free survival rates are significantly better in patients who undergo surgery and have metastases fully removed compared to those who receive only medical treatment.
The decision for surgery must always be approved by an oncology specialist or a multidisciplinary oncology board.
Surgical Methods for Lung Metastasis
- Removal of only the metastatic mass
- Segment removal
- Removal of the affected lobe
- Complete removal of the lung (very rare)
An open surgery approach is preferred for removing metastases. It is believed that very small metastases may not be visible with minimally invasive (VATS) methods. Therefore, open surgery is more commonly used for metastasis operations. However, minimally invasive lung surgeries are becoming increasingly successful.
Risks of Surgery
- Prolonged air leakage from the lung
- Bleeding
- Risks associated with anesthesia (e.g., heart attack, blood clots)
- Infections
How Long Is the Hospital Stay for Surgery?
The average hospital stay for lung metastasis surgery is 3–4 days.
How Is Lung Metastasis Surgery Performed?
In the minimally invasive method, a 1 cm incision is made between the ribs to insert a surgical camera. The metastatic area is visualized, and medical instruments are used to partially remove the affected lung tissue. A drain is placed through the incision to complete the procedure.
In the open surgery method, a 15 cm incision is made between the ribs. The metastasis is located manually and removed using the appropriate surgical method.
Will Radiotherapy or Chemotherapy Be Required After Surgery?
Depending on the pathology results and whether the metastases were fully removed, chemotherapy and/or radiotherapy may be applied as additional treatments. This is not necessary for every patient.
