Areas of Expertise
Lung Metastases

Many cancers spread into the lungs, and there are situations when removal of these metastatic nodules improves outcome. Surgery for lung metastases is indicated when the original tumor in another part of the body has been controlled and there are isolated metastases remaining in the chest. USC thoracic surgeons have extensive experience in removing metastatic nodules from the lungs from the chest due to a variety of tumors, such as colorectal cancer, germ cell tumors, liver cancers, sarcoma, melanoma, renal cell carcinoma, and other tumor types. They work closely with oncologists in choosing the appropriate circumstances to intervene and in coordinating chemotherapy with surgery. In many circumstances, patients with metastatic disease to multiple sites are managed with a combination of different surgeons who each take care of the different metastatic site under their expertise. Overall, the USC team takes an extremely aggressive approach to metastatic disease to the chest.

Our Approach

• Multidisciplinary team approach with a close working relationship between USC thoracic surgeons and the treating oncologist to develop the most appropriate, aggressive approach to eradicating all metastatic disease
• Minimally invasive lung resection utilizing video-assisted thoracoscopic surgery (VATS) or the da Vinci robotic system to minimize pain and accelerate full recovery
• Combined techniques of surgery with stereotactic radiation or ablation technology to maximize the chance at cure with preservation of lung
• Combined surgeries to resect metastatic tumors from multiple sites, such as the lung and the liver from colorectal cancer
• A well established reputation of taking an aggressive approach to the treatment of metastatic disease

Mechanism of Disease

Cancers of the body can metastasize or spread into the lungs or lymph nodes of the chest. This happens when circulating tumor cells in the bloodstream migrate into the chest and have the biologic ability to survive in the lung or lymph nodes of the chest. These situations are considered stage IV disease, but a nihilistic approach may not necessarily be warranted. In many situations, an aggressive approach to eradicating all areas of metastases has been successful in improving survival.

Treatment Options

Working closely with the patient’s oncologist, USC thoracic surgeons have an extensive record of successfully removing metastatic tumors in the lungs or lymph nodes of the chest. This typically requires removal of only a part of the lung with wedge resections, although sometimes a lobectomy is required. Whenever possible, a minimally invasive approach is taken, which can be either with a video-assisted thoracoscopic surgery or VATS approach for a wedge resection, or with the newer da Vinci robotic system for a lobectomy. In the past, surgeons have advocated using a large incision or thoracotomy to remove these metastatic tumors in order to feel for nodules that were missed by radiographic imaging. However, today’s CT scans have excellent resolution and it is extremely uncommon to miss a nodule in the lung because of poor quality scans. Patients benefit from this with smaller incisions, faster recovery, and less pain.

When numerous sites of metastatic disease are present and surgical resection alone cannot eradicate the disease, sometimes a combined approach may be warranted with radiation therapy or ablative therapy. This combines lung resection with stereotactic radiotherapy (Cyberknife®) or ablation to preserve lung tissue when appropriate. Chemotherapy is obviously a major component of treatment in these situations, and a multidisciplinary approach is critical for maximizing successful outcomes.

Treatment Outcomes

Accumulated experience from international centers proves the beneficial effect of an aggressive approach to lung metastases of numerous cancer types. There is no specific type of tumor where this cannot be done, but the treatment plan must be tailored to the circumstances surrounding an individual’s condition.  With this approach, USC thoracic surgeons have been able to successfully eradicate metastatic nodules in the lungs, and with coordinated care with the oncologist, patients have enjoyed great long term outcomes.

Future Research