Not all experts agree on the role of surgery for advanced lung cancer. Advanced lung cancer is usually due to spread onto vital organs (T4), lymph nodes in the mediastinum (N2), to the other lung (M1a) or anywhere else outside the chest (M1b).
Surgery for cancer that has spread to the mediastinal lymph nodes (N2)
Never has there been more research but more confusion in any aspect of lung cancer management. Whilst there have been few clinical trials that address the benefits of surgery for early lung cancer there have been 7 studies about the role of surgery for cancer that has spread to the mediastinal lymph nodes. They all tend to report the same outcomes, there is no difference in overall survival in patients who receive chemotherapy and radiotherapy versus chemotherapy and surgery. In studies of patients that receive chemo-radiotherapy versus chemo-radiotherapy and surgery, recurrence of cancer was lower in those who received the additional surgery.
Therefore surgery has the same outcome as medical therapy and at best offers lower recurrence rates of cancer as part of multimodality management in this setting.
Surgery for cancer that has spread to vital organs (T4)
In general, the advanced disease setting has been applied when the cancer has spread to vital structures (such as the spine or heart). In selected cases, surgery may be possible. This usually involves more than one team of surgeons (for example a chest surgeon and a spinal surgeon) and is offered to patients where there is the possibility of complete resection (removal of all cancer).
Surgery for cancer that has spread to the other lung (M1a)
In selected patients with good lung function, good results have been achieved with surgery on both lungs. This is especially relevant to a particular sub-type of cancer known as minimally-invasive adenocarcinoma that has a tendency to spread to both lungs.
Surgery for lung cancer that has spread outside the chest (M1b)
The specialist multi-disciplinary teams that I work with are increasingly looking for the best treatment in patients with limited disease. In many cases, radical treatment may not be appropriate. In selected patients, radical multimodality management (e.g. multiple surgery, ablative radiotherapy and surgery) may be offered when the disease is confined a limited number of sites. It is not known however, if such an aggressive approach would result to an improvement in the length of life as data on this approach is limited.
If you would like to discuss your individual management, please contact me.