roadrunner wrote:Does this change their approach at all? Is there a surgical
option for the 2.2cm nodule?
Hello, PrayingforCCR,
If we are talking only about this nodule, there are options for it. Options range from surgical ones (but you are just leaving a VATS session) to simpler ones, like ablation. Of course, the usage any procedure needs to be carefully evaluated due to the location of the met, the possible presence of large blood vessels, etc...
Take a look at the link below:
https://www.annalsofoncology.org/article/S0923-7534(19)31500-5/fulltext#:~:text=Conclusion-,Radiofrequency%20is%20an%20option%20for%20treatment%20of%20small%20size%20lung,ones%20below%202%E2%80%933%20cm
Regarding radio ablation... I believe 2.2cm is on the limit of the acceptance size for radio ablation, but if needed theoretically you can just use larger caliber ammo, which, in this case is microwave ablation.
I am personally not a huge fan of SBRT, since it could make futures surgeries on the site more difficult due to tissue damage. On top of the "hot" ablations above there is also crio ablation, etc...
So, if the question was only about the 2.2cm nodule I believe the answer would be "there surely are treatments". The tricky part is not about the "surgical option", but the "approach" you mentioned above.
For any kind of surgery, surgeons are always looking for the big picture before giving green light to execute any procedure. Their main concern is to use a procedure to remove the 2.2cm nodule, which will surely also damage part of the surrounding lung tissue and then have more nodules in the near future to also remove, which will damage more tissue, etc... For everything I could read between the lines on papers for lung met removal, surgeons are always trying to use their procedures as a silver bullet, so, it will damage a little, but if there are no big probability of more mets on the long run, then it is ok.
I believe you need to discuss with a good surgeon that is aware of the treatment you are doing and the real possibility to have no more mets in the future, since your treatment could kill all the new small ones.