Being told the cancer has returned after an operation is often heard as the end of curative treatment. It is not always. Cancer can come back in the chest alone, without having spread — and where that is what has happened, it can sometimes be removed. Dr Lawrence Okiror performs robotic navigational bronchoscopy to sample the new area and carries out the surgery that follows, keeping one surgeon across the whole pathway. Second opinions at London Bridge Hospital and The Lister Chelsea within 2–3 working days. Self-referrals welcome.
Last reviewed: August 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
The sentence most people are given is that the cancer has come back, and the meaning most people take from it is that it is now in the bloodstream and surgery has failed. That belief is older than the tests that can check it. It was formed when there was no reliable way to look at the rest of the body.
There now is. Where scans show the disease is confined to the chest, and a sample confirms what it is, a further operation is a real question rather than a closed one. Request a second opinion within 2–3 days →
The belief that recurrence after surgery means the cancer is in the bloodstream is deeply held, and it is held by patients and doctors alike. It has a history. It was formed at a time when there was no way of examining the whole body reliably, so the safest assumption was that if cancer had reappeared once, it was probably present in places nobody could see.
That assumption was reasonable then. It is now testable. A PET-CT scan examines the entire body for active disease. An MRI of the brain looks at the one place a PET scan sees poorly. Together they answer, with far more confidence than was once possible, whether this is one problem or many.
Sometimes the answer is that disease is present in several places, and treatment given throughout the body is the right approach. But sometimes the answer is that there is one area, in the chest, and nothing else. That patient is in a different position from the one the old assumption describes — and the difference is only discovered by looking.
On a scan they can look identical. The distinction is made in the laboratory, by comparing the new tissue against the tumour removed the first time. If the two match closely in type, pattern and detail, it is likely the same disease returning. If they differ, it is likely something new that has started on its own.
This matters because the two are staged and treated differently, and because patients are frequently given the more pessimistic of the two interpretations by default. Where the interval since the first operation is long, a new primary is a real possibility and worth establishing rather than assuming. More on a new lung cancer years later →
Operating on a chest that has been operated on before is a different task from operating on one that has not. The tissue planes that a surgeon normally works along have been disturbed, and healing has left scar tissue that binds structures together which were previously separate. Everything takes longer and requires more care.
None of that makes it impossible. It makes it a specific kind of operation, best done by someone who does it regularly and who has the tools that suit it. Robotic surgery is particularly useful in a previously operated chest: the magnified three-dimensional view and the fine instrument control help most precisely where scarring makes the anatomy harder to read.
Redo lung surgery is not something every thoracic unit does often, and it is not something any one surgeon does alone. It is a small part of the workload of most units and a regular part of Dr Okiror’s.
The practical point for a patient is continuity: the same surgeon samples the new area with robotic navigational bronchoscopy, discusses the result in the multidisciplinary meeting, and carries out the operation. Nothing is handed over and re-explained between the diagnosis and the treatment.
The sequence has one purpose: to establish whether this is one problem or several. The PET-CT looks everywhere at once. The brain MRI covers the site a PET scan sees least well. If either finds disease elsewhere, the situation is different and surgery is not the answer.
If both are clear, the question becomes whether the single area can be removed and whether you can withstand the operation. That is where breathing tests and fitness assessment come in, and where the previous operation matters most — because the starting point is a lung that has already lost part of itself.
This is the part of the pathway that most often goes wrong, and it goes wrong in both directions. People are told the cancer has returned when the area turns out to be scarring, and people are watched for months on the assumption that an area is scarring when it is cancer. The scan alone cannot separate them, and a treated chest produces confusing images for a long time.
Robotic navigational bronchoscopy is the most accurate method currently available for sampling small and deeply placed areas within the lung. It is not yet widely available — the equipment is expensive and the training specific, and most UK units do not offer it. Your CT scan is used to build a three-dimensional map of the airways, and a fine steerable instrument is guided along it to the target. You are asleep, there is no incision, and most people go home the same day.
Dr Okiror performs it himself, in his NHS practice at Guy’s and St Thomas’ and privately at London Bridge Hospital, and performs the operation that follows. More on robotic navigational bronchoscopy →
This single fact shapes how a second operation is planned. The goal is not simply to remove the cancer; it is to remove the cancer while leaving behind as much working lung as the situation allows. Those two aims usually point the same way, but not always, and where they conflict the operation has to be designed rather than defaulted to.
There is a second reason, less often explained. Losing an entire lung does not only reduce breathing capacity. It removes future options. Radiotherapy to the remaining lung becomes far more difficult, because there is no spare capacity to absorb any injury. A patient with one lung who later develops another problem has fewer routes available than one who kept two.
A lung is not one structure but a set of segments, each with its own airway and blood supply. That anatomy allows a surgeon to remove one segment and leave the rest working. Performed properly, a segmentectomy is not a compromise operation — it is an anatomical resection with a proper margin and the lymph glands sampled, done to a smaller scale.
It is harder in a previously operated chest, and harder again where the segment sits close to the site of the earlier surgery. This is the operation where the extra precision of the robotic platform earns its place. Dye and infrared imaging can also be used during the operation to confirm that the lung being preserved is receiving blood and genuinely working. More on robotic segmentectomy →
Dr Okiror has published a case of exactly this situation: a patient who had already undergone salvage removal of a lung after chemoradiotherapy, and who later developed a single deposit in the chest wall near the shoulder blade. Radiotherapy was not possible, because delivering it would have meant irradiating the only remaining lung. The deposit was removed surgically with reconstruction, and the patient remained free of disease at follow-up.1
That case is not offered as a promise. It is offered because it illustrates the reasoning: when one treatment is closed off by what has gone before, the question becomes what remains open rather than whether anything does.
A standard breathing test gives one overall number. It cannot show which parts of the lung are contributing. Where damage is uneven — which it usually is after surgery, and always is where there is emphysema — that number can understate how much useful lung remains, particularly if the area now being considered for removal was contributing very little anyway. More on borderline lung function →
It is also worth saying that fitness can change in both directions. It declines with age and with treatment. But it also recovers — someone judged unfit during a difficult course of chemotherapy may be a different person eighteen months later. A judgement about operability made at a hard moment does not automatically hold years afterwards, and it is worth asking whether it has been revisited. More on fitness for lung surgery →
The reason is partly selection. Patients being considered for a second operation have already proved they can recover from one, and are being chosen carefully for the second. It is also partly that these operations tend to be smaller: a segmentectomy or wedge rather than a lobectomy.
The honest position is that a second operation carries real risks, that it is technically harder than the first, and that those risks should be set out plainly before you decide. What it is not is a step into unknown territory or something that reasonable surgeons will not attempt.
There is a part of this that has nothing to do with the operation. You have done it before. You know what the drains feel like and how the first night goes, and there is no unfamiliarity to carry you through it. Most people find the second recovery harder in that specific sense, even where it is medically smoother.
What helps is knowing in advance that this is normal and expected rather than a sign of something going wrong. More on recovery after lung surgery →
A proportion of patients who come for an opinion about a second operation leave with the advice that surgery is not the right treatment for them. That is a legitimate outcome of the consultation, and it is worth saying so directly on a page like this one. The value of the assessment lies in the question being properly asked, not in any particular answer to it.
| Situation | Suggested action |
|---|---|
| New area at or near a previous resection site | Tissue before treatment intent is fixed — scarring and recurrence are not separable on imaging |
| Single site of recurrence, PET and brain imaging clear | Surgical opinion reasonable before defaulting to systemic treatment |
| Recurrence in a previously irradiated field | Radiotherapy may be closed off; surgical assessment is the remaining radical option |
| Ipsilateral recurrence where completion pneumonectomy is implied | Assessment for lung-sparing alternatives before that operation is accepted |
| Long interval since first resection | Compare against the original specimen — a new primary carries a different outlook from recurrence |
| Patient judged unfit during earlier treatment | Reassess — operability judgements made during systemic therapy may no longer hold |
Referrals and self-referrals are seen at London Bridge Hospital and The Lister Chelsea, usually within 2–3 working days. Imaging and previous operation notes can be reviewed in advance. Clinic letters go to GPs electronically within two working days, and within three working hours where urgent.
If you have been told the cancer has returned and that nothing further can be done surgically, an independent review of the imaging and the fitness assessment is reasonable. Most patients are seen within 2–3 working days.
Book a Consultation →Or call Jo Mitchelson:
020 7952 2882
If lung cancer has returned after an operation and surgery has been ruled out without restaging or a sample, the question has not yet been fully asked. Second opinions at London Bridge Hospital and The Lister Chelsea within 2–3 working days. Self-referrals welcome.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
St Thomas’ Hospital #1 UK · Guy’s Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026
Lung-sparing resection — often what makes a second operation possible.
Robotic Navigational BronchoscopySampling small, deep areas through the airways with no cut in the chest wall.
Two Lung Cancers at OnceWhen two tumours are two separate cancers rather than one that has spread.
Borderline Lung FunctionRegional mapping when a standard breathing test suggests surgery is not possible.
Fitness for Lung SurgeryBreathlessness, operative risk and cardiac risk — and when to reassess.
Robotic Lung SurgeryThe platform that matters most where scarring makes the anatomy harder to read.
Lung Cancer Surgery in 2026The full pathway from diagnosis through surgery to systemic therapy.
Lung Cancer Second OpinionIndependent review of imaging, staging and treatment plan within 2–3 working days.