For some patients, it is possible to consider surgery to remove a single lung metastasis or a number of metastases.  

There are several factors that need to be thought about before having surgery for lung metastases:

• the primary (original) cancer, or sarcoma, should be controlled
• all other sites of cancer spread, outside of the lungs, should also be controlled
• after surgery you will need enough healthy lung for a good quality of life
• it is possible to offer surgery where a patient has lung metastases on both the left and right lung, but these may need two separate operations.

The operation

For most patients, a lung metastasectomy will involve having a thoracotomy – an open lung operation which includes a cut between the ribs of the chest. Occasionally, it may be possible to undergo keyhole surgery to check the lung for possible sites of metastases. 

For some patients, the metastasis may be present in the space between the two lungs, known as the mediastinum. Depending on the location of the metastasis, it may be necessary to have an operation known as a sternotomy, where a cut is made through the breast bone.

Each lung is made up of lobes – two on the left and three on the right. Usually the metastasis can be removed in a small wedge of healthy tissue, which the surgeon does to try to make sure that all of the cancer has been removed. This means that your surgeon does not have to remove a larger segment or whole lobe of the lung. 

The surgeon may also use a laser during the surgery that allows them to make very fine cuts around the metastasis and avoid healthy tissue. This can also be useful where a large number of metastases need to be removed. 

After the operation

All the lung tissue and metastases removed during the operation will be sent to the laboratory for further tests. This provides you and your doctors with the most accurate picture of your cancer. The results can take a number of days to process and may not be available before you go home. If this is the case, the results will be discussed with you when you come back to hospital for your clinical appointment.

These tests can show or confirm:

• the type of cancer or sarcoma
• the number of metastases removed
• whether the tumour cells were still viable (alive)
• whether cancer cells were or were not malignant (for patients with germ cell or testicular cancer)