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    Lung Metastasis Surgery (Metastasectomy)
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    Lung Metastasis Surgery (Metastasectomy)

    Last Updated 14 March 2026
    Ingredients

    Lung metastasis surgery is the surgical removal of these tumor foci when cancer that starts in another organ of the body spreads to the lungs.

    This procedure, called “metastasectomy” in the medical literature, is part of a multidisciplinary treatment strategy jointly carried out by oncology and thoracic surgery.

    In the past, cancers that spread throughout the body were seen as a “home care” stage, but today, long-term survival in the metastatic stage has become possible thanks to surgical techniques and chemotherapy combinations.

    The main purpose of this surgery is to control the disease by resetting the tumor load in the lung and to extend the patient’s life expectancy in a quality way.

    What is Lung Metastasis? Which Cancers Spread to the Lungs?

    Lung metastasis is when cells that break away from the “primary” focus of a cancer settle in the lung tissue through the blood or lymph and form new tumors there.

    Since the lungs are an organ where all the blood in the body is filtered, it is one of the most common areas where metastatic cells settle.

    Many different types of cancer can spread to the lungs, but in clinical practice, we most commonly encounter lung metastases in the following cancers:

    • Colorectal Cancers: Bowel and rectal cancers are among the types that spread to the lungs the most.
    • Soft Tissue and Bone Sarcomas: Lung metastasis surgery is vital for types like osteosarcoma.
    • Kidney (Renal Cell) Cancer: Kidney tumors often form solitary (singular) foci in the lung.
    • Breast Cancer: Surgical options can be considered along with hormonal therapies.
    • Testicular and Gynecological Cancers: Some types respond perfectly to surgery.

    Who is Lung Metastasis Surgery Applied to? Surgery Criteria

    Not every patient with metastases in the lung is a suitable candidate for surgery.

    In order to make a decision for metastasectomy, certain medical conditions known as the “Thomford Criteria”, which have been modernized over the years, must be met.

    At this stage, the decision of the oncology council is combined with the technical facilities of the surgeon and a patient-specific road map is drawn.

    Requirements for Metastasectomy

    In order for surgical intervention to benefit the patient, it is preferred to have the following conditions together:

    1. Control of Primary Tumor: The main focus where the cancer started (e.g., the intestine or kidney) must have been completely treated or surgically removed.
    2. Absence of extrapulmonary metastasis: There should be no active, uncontrollable spread in any part of the body other than the lungs (brain, liver, etc.).
    3. Technically Removable: All tumor foci in the lung should be completely surgically clearable (R0 resection).
    4. Adequate Lung Reserve: After the tumors are removed, the remaining lung tissue should be capable of allowing the patient to live comfortably.

    Conditions That Prevent Surgery

    If the tumors in the lung are very widely distributed in both lungs and there will be not enough tissue for the patient to breathe after surgery, surgery is not preferred.

    In addition, conditions such as the patient’s general health condition, advanced heart failure or severe respiratory failure may increase the surgical risk to an unacceptable level.

    In cases where systemic control (such as non-response to chemotherapy) cannot be achieved, surgery may be kept on hold as it will not change the course of the disease.

    What are the Symptoms of Lung Metastasis?

    Lung metastases usually progress insidiously and do not cause any complaints in the initial stages.

    Many patients learn about the presence of metastasis on tomography taken during routine follow-ups of their primary cancer.

    However, when tumors grow larger or move closer to the airways, the following symptoms may occur:

    • Cough: It is usually dry and stubborn in character.
    • Shortness of Breath: It occurs when tumors narrow the lung volume or accumulate fluid in the chest cavity.
    • Chest Pain: If the tumor is located close to the chest wall or pleura, stinging pain is felt.
    • Bloody Sputum: It can occur as a result of the tumor damaging a bronchial wall.
    • Fatigue and Weight Loss: It is a general symptom of advanced oncological processes.

    Diagnosis and Diagnostic Methods in Lung Metastases

    Correct diagnosis is the most critical stage to determine the limits of surgery and protect the patient from unnecessary surgery.

    PET-CT and Thin Slice Computed Tomography

    The cornerstone of the diagnostic process is the examination of the lungs with high-resolution and thin-section (1-2 mm) Computed Tomography (CT).

    CT shows the exact location and number of all foci that need to be removed during surgery.

    PET-CT, on the other hand, is used to understand whether there is any other involvement in the rest of the body and to measure the metabolic activity (cancer potential) of lesions in the lung.

    Biopsy Necessity and EBUS Application

    Sometimes it is not clear whether the spots on the lung are metastases or another disease (infection, fungus, etc.).

    In this case, needle biopsy can be performed with the EBUS (Endobronchial Ultrasonography) method, especially to evaluate the mediastinal lymph nodes.

    If the lesion is very far out of the lung, the tissue diagnosis is clarified by performing a biopsy under the guidance of tomography.

    Prof. Dr. Levent Alpay: Our rule in metastasis surgery is: “Remove all tumors you can find, but preserve the patient’s breathing tissue.” To establish this balance, we look not only at radiological images but also at the patient’s clinical history. If we believe that all foci can be cleaned and the patient can do his own work after surgery, surgery is the most powerful weapon of oncological treatment.

    Lung Metastasis Surgery Methods

    The basic surgical principle in lung metastasectomy is to remove the tumor tissue with a very small amount of safe surgical margins around it.

    In order to preserve the main functions of the lung, tissue-sparing approaches are preferred instead of surgeries with large tissue loss in primary lung cancers.

    Today, with the development of technology, these operations are performed with less painful and more sensitive techniques.

    Metastasectomy with Closed Lung Surgery (VATS)

    Video-Assisted Thoracoscopic Surgery (VATS) is a modern and least harmful method for removing lung metastases.

    Thanks to the camera and surgical instruments placed through small incisions, metastases located close to the outer part of the lung are easily cleaned.

    The biggest advantage of the closed method is that it tires the patient’s immune system less and allows him to return to oncological treatments (chemotherapy, etc.) much faster.

    Lung Metastasis Surgery with Laser

    Laser technology is a great revolution, especially for patients with multiple metastases in both lungs.

    Laser surgery vaporizes or cuts out only the tumor focus, preserving healthy tissue around the tumor with almost zero loss.

    Thanks to this method, metastasis foci that cannot be removed with normal surgical sutures can be removed without impairing lung capacity.

    Wedge Resection (Wedge Resection) Technique

    Wedge resection is the process of removing the tumor in a triangular (wedge) shape along with some healthy tissue around it.

    It is the most commonly used technique in metastasis surgery because it targets only the diseased area without sacrificing the lobe of the lung.

    If the metastasis is too deep in the lung or close to the main vessels, techniques that require larger tissue removal, such as segmentectomy, may be used, although rarely.

    Metastasis Surgery Methods and Comparison Table

    MethodTechnical SpecificationAdvantageRecovery Time
    VATS (Off)Small incision with cameraLow pain, fast recovery2 – 4 Days
    Laser SurgeryPrecise laser beamMaximum tissue preservation3 – 5 Days
    Wedge ResectionWedge removal with staplerPrecise surgical margin control3 – 5 Days
    Open SurgeryManual examination (Palpation)Feel small foci by hand5 – 7 Days

    Advantages of Metastasis Surgery and Survival Times

    Scientific data show that metastasectomy performed in suitable patients significantly prolongs life expectancy compared to patients receiving only drug therapy.

    Especially in colorectal cancer and sarcoma metastases, 5-year survival rates after surgery can be as high as 40% to 60%.

    Since surgical intervention reduces the tumor burden, it increases the effectiveness of chemotherapy and supports the body’s power to fight cancer.

    Postoperative Recovery Process and Oncological Follow-up

    After surgery, patients are usually hosted in the hospital for 3 to 5 days.

    In operations performed with the closed method, patients can usually start their daily lives within 1 week and additional oncological treatments within 2-3 weeks.

    The follow-up process is very critical; During the first 2 years after surgery, the lungs are kept under control with tomography and necessary blood tests every 3 months.

    Prof. Dr. Levent Alpay: Metastasis surgery is not the end, it is a strategic part of a long struggle. Before we go to the operating table, we always tell our patients: This is a team effort. We surgically clean the field, and our oncologists provide systemic protection. When this harmony is achieved, it is possible to get satisfactory results even in our patients in the metastasis stage.

    Case Experience (Anonymous): During the routine follow-up of a 54-year-old patient who was followed up for colon cancer, a total of 5 metastatic foci were detected in both lungs. After the decision taken by the oncology council, laser-assisted surgery was performed first on the right lung and a month later on the left lung. Our patient, whose all foci were cleared and lung capacity was preserved, still continues his life without disease 3 years after the operation.

    For a detailed evaluation of the surgical treatment of lung metastases, you can seek expert opinion and make an appointment with our clinic.

    Frequently Asked Questions

    Is Surgery Performed If There Are Metastases in Both Lungs?

    Yes, involvement in both lungs does not prevent surgery; Generally, all foci can be cleaned with two-session surgeries or laser surgery.

    How Many Times Can Lung Metastasis Surgery Be Repeated?

    As long as the lung capacity is appropriate and the newly emerging foci are limited, metastasis surgery can be successfully repeated more than once (3 or more).

    Is Chemotherapy Necessary After Surgery?

    Although surgery removes the tumor, supportive chemotherapy or smart drug therapy is usually recommended by the oncologist to eliminate the risks at the microscopic level.

    Scientific Bibliography

    Medically Reviewed For informational purposes only

    Prof. Dr. Levent Alpay

    Prof. Dr. Levent Alpay

    As a Thoracic Surgeon, he continues his scientific studies and clinical practices on lung cancer surgery, robotic surgery and minimally invasive methods at Medicana Ataköy Hospital.