Metastatic cancer is cancer that has spread from its original site to another part of the body. Recurrent cancer is cancer that has returned after treatment and may recur at the original site, in nearby tissues or lymph nodes, or in a distant organ.
Surgery may be considered when recurrent disease or a limited number of metastases can be removed safely. It may also be used to reduce tumour burden, prevent complications or relieve symptoms such as pain, bleeding, obstruction or pressure on an organ.
The goal of surgery varies. In carefully selected patients, it may support long-term disease control. In others, it forms part of a combined treatment plan or is performed primarily to improve comfort and quality of life. At Apollo Cancer Centres, each case is reviewed by a multidisciplinary team to determine whether the expected benefit justifies the risks of surgery.
- Have a local recurrence that can be removed with an appropriate surgical margin
- Have recurrence in nearby tissues or lymph nodes that remains surgically removable
- Have a limited number of metastases confined to one organ or a small number of sites
- Have a primary cancer that is controlled or can be treated effectively
- Have disease that has remained stable or responded to systemic treatment
- Have had a sufficiently long period without disease, where this is relevant to the cancer type
- Have metastatic deposits that can all be removed or treated locally
- Need surgery to reduce tumour burden as part of a wider treatment plan
- Have pain, bleeding, obstruction, perforation or pressure caused by a tumour
- Are at risk of fracture, organ damage or another serious cancer-related complication
- Need tissue to confirm recurrence or perform biomarker or molecular testing
- Are medically fit for the planned operation and expected recovery
How the Procedure is Performed
Before the Procedure
Before surgery for metastatic or recurrent cancer:
The team reviews the original diagnosis, previous histopathology, treatments received and response to treatment.
Imaging is performed to determine the number, size and location of recurrent or metastatic tumours and to look for disease elsewhere in the body.
A biopsy may be recommended to confirm recurrence or obtain tissue for biomarker or molecular testing when the result could affect treatment.
Previous operations and radiation therapy are reviewed because they may affect tissue planes, healing and the complexity of further surgery.
The case is discussed by a multidisciplinary tumour board to compare surgery with systemic therapy, radiation therapy, ablation or other local treatments.
The team determines whether all known diseases can be treated and whether the primary cancer is controlled.
Treatment may be given before surgery to assess the behaviour of the cancer, shrink the tumours or treat microscopic disease elsewhere in the body.
The surgeon explains whether the aim is long-term disease control, reduction of tumour burden, prevention of complications or symptom relief.
The possibility of removing part or all of an affected organ, nearby structures or lymph nodes is discussed when relevant.
Reconstructive surgery may be planned if previous treatment or the proposed operation is expected to leave a significant tissue defect.
The patient’s fitness for surgery and anesthesia is evaluated. This may include blood tests, heart and lung assessments, nutritional evaluation and consultation with an anesthetist.
The need for drains, tubes, blood transfusion or a temporary or permanent stoma is discussed whenever it can be anticipated.
Instructions are provided about fasting, medications, smoking cessation and hospital admission.
During the Procedure
Surgery is usually performed under general anesthesia.
An open, minimally invasive or robotic-assisted approach may be used depending on the cancer site, previous treatment and complexity of the procedure.
The surgeon examines the affected area and confirms whether the known disease can be removed safely.
A local or regional recurrence is removed with an appropriate margin of surrounding tissue whenever feasible.
Metastatic deposits may be removed from the affected organ or organs. This is sometimes called metastasectomy.
The original tumour and metastatic deposits may be treated during the same operation or through separate staged procedures.
Part or all of an affected organ or nearby structure may need to be removed.
Nearby lymph nodes may be sampled or removed when required for treatment or staging.
In selected cases, surgery may be combined with another local treatment, such as tumour ablation.
A pathologist may examine tissue during the operation to assess a surgical margin or clarify the nature of a suspicious area.
Reconstruction may be performed to restore coverage, continuity or function after tumour removal.
If the aim is symptom relief, the surgeon may remove or bypass an obstruction, control bleeding, stabilise a weakened bone, relieve pressure or create a stoma.
If more extensive disease is found than expected, the surgeon may modify or stop the planned procedure when continuing would not provide meaningful benefit.
Drains, tubes or a temporary or permanent stoma may be placed when required.
All removed tissue is sent for detailed histopathological examination.
The duration of surgery varies according to the site, number and extent of tumours and whether more than one organ or reconstruction is involved.
After the Procedure
Recovery: Recovery depends on the site and extent of surgery, previous treatments, the patient’s overall health and whether more than one organ has been treated.
Hospital Stay: Some limited procedures require only a short stay, while complex or multi-organ operations may require several days or longer. Some patients may initially need high-dependency or intensive care monitoring.
Pain Management: Pain is managed using a personalised combination of medicines and, where appropriate, an epidural or nerve block.
Nutrition and Mobility: Fluids and food are restarted according to the operation. Patients are encouraged to perform breathing exercises, sit up and begin walking as soon as it is safe.
Wound and Drain Care: The team provides instructions for caring for the incision and any drains, tubes or stoma.
Histopathology Review: The final report confirms that the removed tissue contains recurrent or metastatic cancer and provides information about margins, tumour biology and treatment response.
Further Treatment: Chemotherapy, targeted therapy, immunotherapy, hormonal therapy or radiation therapy may be recommended after recovery.
Symptom Assessment: When surgery is performed for symptom relief, the team assesses whether pain, bleeding, obstruction or another problem has improved.
Resuming Routine: Return to work, driving, exercise and normal activities is gradual. Recovery may take several weeks or longer after major surgery.
Follow-up Care: Follow-up includes assessment of healing, review of the pathology findings and surveillance for disease at the treated site or elsewhere.
Key Advantages
- Fever, chills or increasing weakness
- Worsening pain that is not controlled by prescribed medication
- Increasing redness, warmth, swelling, discharge or bleeding from the incision
- Persistent vomiting or inability to eat or drink
- Increasing abdominal swelling or inability to pass urine, gas or stool as advised
- New weakness, numbness or loss of movement
- Shortness of breath, chest pain or coughing up blood
- New swelling or pain in an arm or leg
- Reduced urine output or another unexpected change in body function
- Return or worsening of the symptom the surgery was intended to relieve
- A problem with a drain, feeding tube, urinary tube or stoma
- Any symptom identified by the surgical team as specific to the procedure
Continuum of Care
Surgery for metastatic or recurrent cancer is usually one part of an ongoing treatment pathway. After surgery, patients may receive:
