The lung is the most common site of metastases in certain solid tumour. For patients with solitary or limited metastases to lung, there is a definite role of Metastatectomy i.e., surgical removal of metastatic nodules especially using Video Assisted Thoracoscopic surgery.

THE CASE

A 50-year-old gentleman, a follow-up case of right-sided Renal Cell Carcinoma was admitted to BLK. He underwent right Radical Nephrectomy four years ago. Post-operative, histopathology suggested stage II Renal Cell Carcinoma with sarcomatoid features. The patient was investigated for complaint of backache. His CT Chest suggested bilateral pulmonary metastasis and PET CT showed single lesion in the right lung lower lobe, one lesion each in left upper lobe and lingular lobe. There was no evidence of metastasis elsewhere.

THE PROCEDURE

In view of patient's sarcomatoid histology and limited lung disease, he was planned for Bilateral Pulmonary Metastatectomy. The patient was optimised with Echocardiography, Pulmonary Function Test and counselled regarding staged resection of bilateral lung lesions. Left posterolateral thoracotomy with excision of both lung lesions were done in one sitting. Four weeks later, Video Assisted Metastatectomy of right lower lobe lesion was done. Final histopathology revealed Metastatic Renal Cell Carcinoma with sarcomatoid features.

THE RESULT

The patient recovered well from surgery. He is advised for follow-up check ups to ensure there are no further complications. He is up and about like a normal fifty-year-old.

Dr. Ashish Goel
Senior Consultant
Surgical Oncology
BLK Cancer Centre
BLK Super Speciality Hospital

“Surgical resection of metastasis to lung from Renal Cancer either alone or in combination with Immunotherapy / Targeted Therapy has shown to be curative or demonstrate better survival advantage compared to patients treated with Systemic Therapy alone. The benefit of surgery is most appropriate in select patients with long disease free interval after primary treatment and metastatic presentation with limited / oligometastatic disease where complete resection is feasible.

Video Assisted Thoracoscopic Metastatectomy (VATS) offers the advantage of Minimal Invasive surgery for removal of lung metastasis with short hospital stay, less postoperative pain and early recovery.”

Dr. Kapil Kumar
Director- BLK Cancer Centre,
HOD- Surgical Oncology
BLK Super Speciality Hospital