Thoracotomy Surgery to Remove Lung Metastases

I wanted to see if anyone has undergone a thoracotomy surgery to remove lung metastases.

My wife Lisa was diagnosed with intrahepatic cholangiocarcinoma in May of 2013. After 8 months of chemotherapy she was able to have a resection surgery, followed by chemo-radiation due to positive margins and positive lymph nodes. Lisa was cancer free for approximately 13 months until her CT scan in February of this year revealed multiple very small lung nodules. At that time, the medical team was not sure if the nodules were metastatic and we opted for surveillance since the nodules were too small to be biopsied without a major surgery. A scan last month showed new nodules and growth of the existing nodules. There are 11 sub-centimeter nodules in total in both lungs. Lisa’s medical team now believes that the nodules are metastatic, but the only way to get a definitive diagnosis is through a thoracotomy surgery.

We consulted with Dr. Javle at MD Anderson, who agreed that the nodules are likely to be metastatic. Dr. Javle believes that we need to get a tissue sample to confirm the diagnosis, surgically remove as many nodules as possible, and perform molecular testing in order to determine the best chemotherapy treatment regimen. On Thursday of this week, Lisa will undergo a segmentectomy of the anterior portion of her right upper lung at MD Anderson, to be followed by systemic chemotherapy. Dr. Javle has also enrolled Lisa in an experimental study utilizing patient derived xenografts (mouse models).

I realize that the lungs are a common site of recurrence; however, my understanding is that most patients who have lung metastases also have metastases elsewhere (i.e. liver, bone, lymph nodes, etc.). Because the primary criteria for pulmonary metastasectomy is the absence of primary or metastatic disease elsewhere, we were told that the thoracotomy surgery to remove lung nodules is pretty rare in the cholangiocarcinoma world. We are grateful that Lisa is able to have this surgery and our heart goes out to all those who are not surgical candidates. I just wanted reach out to this group to see if anyone has any experience with isolated lung metastases or a thoracotomy surgery to remove lung nodules.