Lung: Surgery (Thoracotomy)

[Ivan]

Discuss conventional lung surgery here

NOTE: for multiple metastases consider laser assisted thoracotomy in Germany - viewforum.php?f=51

[Olga]

This article is written about the different sarcoma - LMS (Leiomyosarcoma) but since it is also slow growing, the article can be used as a part of supportive articles when someone applies for the lung surgery to remove the mets even if this is a repeated surgery, as the authors conclude that "Long–term survival is achievable with an aggressive approach toward pulmonary metastasectomy and repeated pulmonary metastasectomy".

http://ats.ctsnetjournals.org/cgi/conte ... /92/4/1202
Ann Thorac Surg 2011;92:1202-1207. doi:10.1016/j.athoracsur.2011.05.052
© 2011 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Repeated and Aggressive Pulmonary Resections for Leiomyosarcoma Metastases Extends Survival
Bryan M. Burt, MD*, Santiago Ocejo, MD, Carlos M. Mery, MD, MPH, Marcelo Dasilva, MD, Raphael Bueno, MD, David J. Sugarbaker, MD, Michael T. Jaklitsch, MD

Division of Thoracic Surgery, The Brigham and Women's Hospital, Boston, Massachusetts

* Address correspondence to Dr Burt, Division of Thoracic Surgery, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (Email: bburt@partners.org).

[Amanda]

Olga,
What is the mets are few and 8mm and under? is it worth removing them even if they are stable? I am asking because i still have 11 all mm size and not moving at all so far... But, they freak me out to be honest and would like to know what you and the others feel i should do :/

[Olga]

I think that you have to ask them to compare these mets not between 2 consecutive scans but with 1-2 years apart and tell you exactly what was the change in 2 years, also ask them to count them and tell you what is the biggest size etc. Post what they said and then we can discuss it further. We were in the situation when our radiologist would say "stable" every time in his report for a year. The reality was that the mets were small and it was hard to notice the change 1.5 mm between the consecutive scans, but when they were compared on a year over year basis, the growth was 5 mm at least. Not funny.

[D.ap]

Olga and Ivan

We are now 1 year from dx and a little over 11 months from our first surgery with Dr. Rolle on our left lung .
Our lung volume is at 68% which is as a result of having had the right lung operated on as well
If scans showed marked growth on the left lung, performed 10 months ago AND the opportunity arises, would you personally return for surgery on the left lung knowing that your lung volume was 68% ?

Thanks in advance
Debbie

[Olga]

Debbie - was first (left) lung the surgery done 11 or 10 months ago? How long ago was the other lung surgery? What do you mean by "If scans showed marked growth on the left lung" - is this scan with the growth the one that is already done? What is the exact growth (marked) - the size change in how long - I am trying to figure out the rate of the growth - mm/month?

[D.ap]

Olga

Left lung, next to heart was performed a little over 10 months ago

Josh states:
Sept 2012 -- VATS
Jan 2013 --left lung laser treated over 70 mets treated
Aug 2013 right lung over 70 treated .June ct with contrast showed 6mm tumor on left lung
August CT was done with no contrast prior to second surgery showed this nodule at maybe 8mm
October CT w contrast showed same tumor at 15mm
I hope this answers your questions

Thank you so much

Deb

[Olga]

The total lung capacity prior to all surgeries is 100%, every lung at 50% of the total volume. At 3 months after the surgery it is at the half of its own due to the swelling as it heals. At 6 months it should go to 70% of it own presurgery volume and at 1 year after the surgery it should be at 80-90% of its own volume.
That makes the right lung now at 25% of the total presurgery volume and the left, earlier operated on lung at 80% from its presurgery half % which is 40% of the total. In total it gives us 65% of the presurgery volume which is about what he has now. If he gets the left lung surgery now, the operated lung looses the half again before it heals and will be at 20% of the total plus the right lung is only at 25 (will be 30% by then), the total is 50% of the volume. Probably still OK but will need oxygen for awhile. I would try to get the right lung to 6 months after the surgery for it to be able to support him after the left is operated again, end of January may be.
The rate of growth of this met is 3mm/month which is to fast if it stays the same, it may slow down after the surgical trauma caused processes calm down as the time goes. If the rate of growth stays the same it is going to be about 25 mm in January, which is OK if Dr,Rolle takes him for the second round surgery but is not OK if it is going to be ablated.
This is all my own non-expert ideas. Did you get any answer from Dr.Rolle and other drs re. possible radiosurgery.