Daniel D in South Korea - Dx 2013

[danieldew7]

Hi Debbie,
The biggest one from both lungs was 1.1 cm taken from left lung.
The decision to do surgery on left lung is that size and the location of met.

[Jorge]

It's amazing the doctor resected 20 mets from your left lung! I'm happy for you and wish you a speedy recover.

[D.ap]

Hi Daniel
How's your recovery going for you ?
Thinking of you today
Love
Debbie

[danieldew7]

Dear Debbie,
Thanks a lot for your concern. My left lung seems recovering well, I've stopped taking pain killer since last week and the pain is very tolerable.
Next CT scan will be on this May.

Best regards,
Daniel D.

[D.ap]

Daniel

The news sounds wonderful .
Your lung volumes ok?

So you will perform scans May and then decide on the remaining lung .
Thanks for checking in

[Olga]

Daniel, it is very important to get the operated lung completely back to normal working status before of the next surgery for the other lung. More walking is the best way. When you sit the lower part of the lungs are suppressed and not completely inflated, so make sure to get up often and to go out for a walk few times a day, you have to be able to walk very fast toward the next surgery. I think they gave you the breathing trainer - try to use it in a correct way, read the instruction.

[D.ap]

Thank you for your response , Daniel .
I agree with Olga. Make sure you're exercising your operated on lung to get it more back to the presurgery condition before moving on the the other lung.
Joshua's second surgery in Germany was cut short because his lung capacity became way too low with his second surgery . Oxygen was too low for Dr Rolle.
Dr Rolle was only able to remove the upper 2 sections of the right lung of the largest tumors.
However Josh returned to the states with , without 70 plus tumors .

That we are thankful for .


Surgeries are certainly a better approach than chemo .
I'm amazed how your doctors were able to remove 20 tumors !

[danieldew7]

Dear Debbie and Olga,
Thanks for your advises. Now I'm able to walk stairs until 17th floor every weekday, do some light taekwondo exercise and give my daughter piggyback.
But for sprint, I'm still wearing out quickly and unable to attain the same record as with before surgery.

Best regards,
Daniel

[D.ap]

Daniel,

It sounds like you are on it with your recovery!
Congratulations. That's wonderful news!
The surgery technique sounds amazing. Do you think the mets were in a place to not cause problems or was it how the surgery was performed?
The 11mm tumor probably was restricting air flow huh as you've lost the cough.
The surgeon was able to obtain positive margins?

[Olga]

I would avoid sprint or any other exercise with the sharp breathing or the hard shakes from the running. One of the most dreadful experiences Ivan had was the pneumothorax - a tear in the post-surgical scar inside of the lung caused it to fill with the air and partially collapse, it lead to an unnecessary surgery to fix this tear. The lung tissue is very delicate and it needs time to heal completely, Ivan's pbeumothorax happened a month after the surgery.

[danieldew7]

Dear Debbie and Olga,
The surgery was due to continuous growth and the location is near with blood vessel.
From the result of CT scan post-surgery, the margin was positive.
Thanks for the exercise advice, I will keep on the steady one instead of rushing it.
Best regards,
Daniel D.

[danieldew7]

Good morning,

Last Friday I just had a visit to check the CT result, my left lung is now clear of any mets, and mets in my right lung is stable and some were grow slightly, the biggest grew from 10.2 mm to 10.4 mm.

Chemotherapy doctor told me that there is no need to do surgery for my right lung now, or do any chemotherapy. However, he predict 100% that other mets will come again. He told me to do X-ray and not CT scan 3 months later.

Lung surgeon do not have any comments other than following chemo doctor's opinion.

Best regards,
Daniel D.

[Olga]

Hi Daniel. thank you for an update. I am a bit puzzled why is the chemotherapy oncologist advises on the surgery? Doesn't the surgeon know better in this area? I would ask this thoracic surgeon if the size of the lung mets is good for the technique he uses for the surgery and if the mets grew - would that make the surgery for this lung more complicated? Given that you already had the surgery for one lung and it is all good for now, why not to have the second one in few months from now - after you have completely recovered. It is understandable that there are most probably other micromets that are not seen in a CT scan resolution now, but removing the bigger ones would hopefully buy you a time to be able to wait for the systemic treatment.

[danieldew7]

Dear Olga,
Even he is aware that cediranib, anlotinib or sutent, he doesn't recommended them because none of them have 100% success rate and he believes that it is fine to leave the rest of mets as they are while waiting for another clinical systemic treatment result.
Both of him and the surgeon were working together, and both of them advised the same conclusion.
Yes it is as you stated that 3 months later if there is 'significant' growth, they will do the surgery at that time.
Best regards,
Daniel D.

[arojussi]

Hi Daniel

I agree with Olga that it is better to have surgeon's opinion about lung mets. If oncologist and surgeon agree there is no problem, but if they disagree I would follow surgeon's recommendations. My personal opinion is that in your situation there is no need for systemic treatment. Thoracotomy right now would also be too aggressive, because thoracotomy causes lung scarring, that makes future surgeries more difficult. On the other hand cryoablation or vats are reasonable in your situation. But asps grows slowly in lungs so you can just wait. If surgeon feels that vats for 2cm met wouldnt be more difficult than vats for 1cm met, then there is most likely no downside in waiting.

Asps seems to respond well to immunotherapies like pd1-inhibitors and new systemig treatments are constantly evolving if you need them in the future.

One last question: was your first surgery just vats or did they perform thoracotomy? I am not very familiar with vats, because all my surgeries were thoracotomies, but as far as I know vats is less invasive. I tried to read previuos posts, but even after that I couldnt figure out if you had just vats or thoracotomy addition to vats.