What is Lung Metastasis, Surgery/Metastasectomy?

Lung/Pulmonary metastases: Cancer in another body organ spreads to the lung. Metastatic cells are the same type of cancer cells as primary cancer cells.

Click to rate this post!
[Total: 1 Average: 5]

akciğer metastazı ameliyatıFor example, if a patient with breast cancer has metastasized to the lung, the cells of the mass removed in the lung are the same as breast cancer cells.
The treatment of these patients is systemic therapy/chemotherapy. In some cases, we remove lung metastases surgically.
During the decision of lung metastasis surgery for these patients, the Oncology specialist, the doctor who performed the previous surgery, Chest Diseases, and Thoracic surgery should decide altogether. The decision is made according to the conclusion of the council.

Metastatic cancer treatment methods are as follows:

  • Systemic Therapy: It includes hormonal, targeted, and biological treatments and chemotherapy
  • Local Treatment
    • Surgery / Metastasectomy
    • Radiotherapy
  • Combination of local and systemic therapy

Metastasis surgery/metastasectomy is decided according to the following features:

  • Primary cancer should be under control.Fully cured (surgically removed/completely cured) of primary cancer/metastasized cancer. If there is a recurrence, this area should be surgically removed or treated with chemotherapy or radiotherapy. The physician treating primary cancer should confirm that this cancer no longer exists elsewhere. If a patient's primary cancer is not under control, lung metastasis surgery is not performed.
    • If there is a necessary condition or the organ is at significant risk, surgery can sometimes be performed even if the primary cancer is not controlled.
  • There should be no metastases in another part of the body/organ other than the lung.
    • Not:Although there are liver and lung metastases in colon cancer, we prefer to remove both.
  • Location of metastatic mass,
  • Number of metastases (if one, two, or more),
  • Presence of metastases in both lungs,
  • The general condition of the patient,
  • The patient's respiratory functions,
  • The type of primary tumor is critical.
  • The time lapse between primary cancer and metastases is also important.
lung metastasis

If there is a systemic spread, why do we perform surgery?

Surgery should always be the first choice in treating lung metastases if the primary cancer is under control and there is no metastasis in another organ. Because in these patients, complete removal of the metastatic mass and metastasis-free organ is curable.

On average, the 5-year survival rate of patients with untreated metastatic disease is less than 5-10%. Numerous studies have shown 5-year survival rates of 30% to 50% for various primary tumors with lung metastasis that are then surgically treated.
These survival rates are far superior to other treatments currently available. Complete resection is the key to long-term survival/recovery, regardless of the primary tumor.
Surgery has very low morbidity and mortality rates and offers a chance for cures in incurable patients.

How is Metastasectomy Surgery Performed?

Before metastasectomy, preoperative evaluation is performed. Patients may undergo a variety of tests such as ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT scan), and positron emission tomography (to check the entire body for metastases), as well as blood tests, to ensure they are suitable for surgery. In some cancers, tumor markers are also studied.

Not:Surgery decision depends on the approval of the oncologist or the oncology council!

How is Lung Metastasis Surgery Performed?

Closed Surgery/Thoracoscopic Surgery/VATS

  • We prefer closed surgery if a single nodule or two nodules are in a location that can be easily removed with VATS. We perform VATS through one or two incisions. After the procedure, we insert a drainage tube through the incision, and the operation is completed.
  • Metastasectomy with VATS
    • Wedge-shaped wedge resection,
    • Removal of a segment of a lobe, thus a segmentectomy,
    • Removal of an entire lobe (pneumonectomy),
    • Lung metastases removal
akciğer metastazları

Open Surgery

We make an incision that allows our hand entrance to the thoracic cavity. What are the advantages of open surgery over closed surgeries?

  • Compared to closed surgery, less tissue is resected. In other words, we resect the tumor so that the surgical margins of cancer will be negative without performing a wide resection like a wedge resection, segmentectomy, or lobectomy. Sometimes, we may need to perform a wedge resection, segmentectomy, or lobectomy due to the tumor size.
  • Removing tiny nodules in closed surgery may be difficult in some cases. It is difficult to determine its location or challenging because of its location. Wide resection may be necessary to remove them. In such patients, the patient may require multiple operations. It is essential to have sufficient lung tissue. For this reason, it is crucial to prefer parenchymal-preserving surgery.
  • Since we palpate the tumor manually in the closed surgery, we find it easy to remove the small nodules, and thus healthy lung tissue is preserved. We also can detect and remove extra nodules that are not visible radiologically.

Of course, VATS has many advantages in terms of comfort, pain, post-operative complications, and the immune system.

  • After the surgery, patients discharge within 3-5 days.

If metastasis is present in both lungs, we repeat the procedure on the other side within 2-3 week intervals.

Post-operative Oncological Treatment

Chemotherapy and radiotherapy administration, in addition to surgical treatments, depends on the pathology result after metastasectomy and whether all the metastases in the lung are resected.

Risks and Complications in Metastasectomy

  • Bleeding
  • Prolonged air leak from the lung
  • Infection, pneumonia
  • Organ dysfunction
  • Post-operative pain

Frequently Asked Questions About Metastasectomy

International literature recommends the surgical removal of metastases as long as possible. The metastasectomy procedure does not completely remove the cancer, but removes the mediator. It is considered that the criteria for disease-free survival of patients who underwent surgery and whose metastases were completely removed, received medical treatment were much better. And it usually increases the chances of survival after this procedure.

The 5-year survival rate of patients with untreated metastatic disease is less than 5-10% on average. For a patient with isolated metastatic disease to the lungs (ie without metastases to other parts of the body), pulmonary metastasectomy (surgical removal of lung tumors) is the best hope for treatment. Numerous studies have shown 5-year survival rates of 30% to 50% for various primary tumors when they have spread to the lungs but are then surgically removed. These survival rates are far superior to other treatments currently available. Irrespective of the primary tumor, complete resection is the key to achieving long-term survival/recovery. Surgery is often recommended, as these operations can be performed with very low morbidity and mortality rates and offer a chance for cure in incurable patients.

If the tumors in the lung can be removed technically and the remaining lung is sufficient after removal, the number may not be significant. We have had cases where we had up to 15-20 metastases in one lung. If the number is very high in the form of a field of metastases, of course, the number is important. Even if metastases are present at the time of identification of the primary tumor (synchronous), resection may be considered.

Leave a Reply

Your email address will not be published.