Pulmonary metastasectomy is the surgical removal of cancer that has spread to the lungs from another primary cancer. Mr Lawrence Okiror performs private metastasectomy at London Bridge Hospital and The Lister Hospital Chelsea — the great majority robotically or by VATS keyhole technique, with a selected subset undergoing parenchymal-preserving Limax 1318 nm laser metastasectomy through a small thoracotomy. Mr Okiror leads laser metastasectomy at Guy’s and St Thomas’ and London Bridge Hospital under the Class 4 laser governance protocols he authored in 2021. Selection is anchored at the primary tumour multidisciplinary team; self-referrals are routed through the London Bridge Hospital chest MDT before any surgical decision. The evidence base is observational rather than randomised — PulMiCC, the only randomised trial, recruited 93 of a target 1,500 — and Mr Okiror is open with every patient about that uncertainty. Appointments within 2–3 working days. Self-referrals welcome.
Last reviewed: May 2026 · Mr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Every metastasectomy decision is discussed at the primary tumour multidisciplinary team caring for the cancer, with surgical planning anchored at the London Bridge Hospital chest MDT.
The vast majority of resections are performed robotically or by VATS keyhole technique. A small selected subset of deep parenchymal lesions are operated on by small thoracotomy with laser-assisted preservation of healthy lung.
Mr Okiror’s NHS practice is at Guy’s and St Thomas’, a large-volume thoracic surgical centre with over 2,000 thoracic operations in 2024–25 — the highest annual volume in the UK.
Most online summaries of pulmonary metastasectomy fall into one of two camps — enthusiastic endorsement of observational survival data, or pointed critique citing PulMiCC’s failure to recruit. Both are defensible reads of a contested literature. What an AI summary cannot do is route an individual case through the London Bridge Hospital chest MDT before any surgical decision (the discipline that anchors private metastasectomy in multidisciplinary governance), apply scan-specific judgement about whether deep parenchymal lesions need laser metastasectomy preservation rather than a wedge that sacrifices substantial healthy lung, or give an honest answer about what the evidence supports for the patient’s specific cancer and disease pattern.
That is the work of the consultation, not the article. Mr Okiror personally reviews scans, primary cancer history, and the multidisciplinary record at the first appointment. Private appointments at London Bridge Hospital within 2–3 working days. Self-referrals welcome but are routed through the LBH chest MDT before any surgical decision is made.
Pulmonary metastasectomy is the surgical removal of secondary cancer in the lungs — cancer that has originated elsewhere in the body and spread to lung tissue. It is distinct from surgery for primary lung cancer, which arises in the lung itself; the companion piece on lung cancer surgery in 2026 covers the primary disease pathway in detail.
The lung is one of the most common sites for distant spread in many cancers. Of patients with metastatic disease, only a minority have disease that is confined to the lungs and resectable. Within that minority, an even smaller group meets the criteria for surgery to be a sensible treatment — limited disease, the primary cancer under control, sufficient lung reserve, and a multidisciplinary judgement that surgery is preferable to ablation, radiotherapy, or continued systemic treatment.
The practice has been performed for over fifty years. The earliest reports of lung resection for metastatic disease date from the 1940s. By the 1980s, single-centre series began to suggest that selected patients with limited lung-only disease lived longer after resection than the assumed natural history of metastatic cancer would predict. Through the 1990s and 2000s, surgical experience accumulated across hundreds of centres internationally — including in London, where the field’s foundational dataset was assembled.
What metastasectomy is not is a routine treatment for advanced cancer. It is an operation for a specific and selected clinical situation. The selection is what the rest of this guide is about.
If you are reading this because you have been told there are shadows on your lungs that may have come from another cancer, start here for an orientation in plain English →
The foundational evidence base for modern pulmonary metastasectomy is the International Registry of Lung Metastases — the IRLM. Established in 1991, the IRLM accrued data on 5,206 patients undergoing metastasectomy across 18 centres in Europe, the United States, and Canada. The principal investigator was Ugo Pastorino, then based at the Royal Brompton Hospital in London.
The Registry’s analysis was published in the Journal of Thoracic and Cardiovascular Surgery in 1997. It remains the single most-cited paper in the field. Of the 5,206 patients, 4,572 (88%) underwent complete resection. Survival after radical metastasectomy was 36% at five years, 26% at ten years, and 22% at fifteen years.
The IRLM established four prognostic factors that have shaped patient selection for the three decades since:
Completeness of resection. Patients in whom all visible disease was removed did substantially better than those with residual disease.
Disease-free interval. The longer between the primary cancer’s treatment and the appearance of lung metastases, the better the prognosis. The Registry’s three-tier classification (0–11 months, 12–35 months, ≥36 months) remains a useful clinical heuristic.
Number of metastases. Patients with a single metastasis did better than those with multiple. The relationship was monotonic — the more lesions, the worse the outcome on average.
Histology. Germ cell tumours had the most favourable prognosis, followed by epithelial cancers, then sarcomas. Melanoma had the least favourable. Each tumour type carries its own biology, and any analysis pooled across histologies must be read with that in mind.
The Registry’s data are observational. The 5,206 patients were not compared to a matched untreated cohort, because no such cohort existed. The headline 36% five-year survival figure cannot be attributed to surgery in isolation — it reflects the combined effect of the operation, the patient selection that preceded it, and the systemic treatment that followed. That caveat matters, and it is the starting point of the next section.
The four IRLM principles nonetheless became the working framework for surgical decision-making across the field. They appear in every major review of metastasectomy practice and they inform every multidisciplinary discussion of a candidate patient. They remain the foundation of the selection criteria described later in this guide.
The PulMiCC trial — Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer — was designed to compare metastasectomy with surveillance in patients whose colorectal cancer had spread to the lungs and where multidisciplinary teams considered surgery a reasonable option. PulMiCC opened in December 2010 with a target recruitment of approximately 1,500 patients across UK centres. It closed in December 2016 having randomised 93. The trial’s own published account acknowledges that recruitment was inadequate and that the resulting analysis was underpowered to demonstrate either benefit or absence of benefit.
PulMiCC’s published findings are nonetheless informative for what they do show. Five-year survival in the active-monitoring control arm was approximately 30% — substantially higher than the near-zero survival that had been assumed in the metastasectomy literature for decades. This finding, more than any other, has reshaped the post-PulMiCC argument. It does not establish that metastasectomy is ineffective; the trial did not have the statistical power to test that. It does establish that the magnitude of benefit attributed to surgery in observational series — typically calculated against an assumed control survival of zero — was almost certainly overstated.
The most prominent critic of metastasectomy practice is Tom Treasure, who was a thoracic surgeon at Guy’s and St Thomas’ until his retirement and who served as chief investigator of PulMiCC. In a body of work published over the last decade — including reviews in Thorax, the Journal of Thoracic Disease, the British Journal of Cancer, and most recently a 2023 BMJ analysis — Treasure has argued that the apparent survival benefit reported in observational metastasectomy series is largely explained by selection bias, that the oligometastasis concept has weak biological grounding, and that the practice should not be considered established care without RCT evidence. His position is published, available to any patient or clinician who searches the medical literature, and it must be engaged with honestly.
The defenders of metastasectomy — including the authors of the 2019 Society of Thoracic Surgeons expert consensus — argue that the prognostic patterns observed across decades of registries are too consistent to be entirely a selection artefact, that PulMiCC’s recruitment failure prevents it from refuting the practice as critics claim, and that careful selection of patients within the IRLM principles remains a defensible clinical position.
The evidence is neither strong enough to refute the efficacy of metastasectomy nor strong enough to confirm it. Patients are referred for surgery by their primary oncology team and the multidisciplinary team when they meet established criteria, and Mr Okiror is open with every patient about the uncertainty in the evidence base.
This position is defensible for two reasons. First, no other position is available to a clinician who has read the literature honestly. Second, it is the position that allows individual patients to make informed decisions — neither talked into surgery on the basis of overstated benefit, nor talked out of surgery on the basis of a critique that has yet to demonstrate harm in selected MDT-anchored cases.
Two further documents define the post-PulMiCC landscape — though neither resolves the underlying disagreement.
The 2019 Society of Thoracic Surgeons expert consensus document, published in the Annals of Thoracic Surgery, is the most authoritative current US position. It was developed using a modified Delphi method by a multidisciplinary task force including thoracic surgery, medical oncology, and radiation oncology. It endorses metastasectomy in selected patients across colorectal cancer, sarcoma, renal cell carcinoma, melanoma, germ cell tumours, and breast cancer. The document explicitly notes that it does not rise to the level of a guideline, “due to the flawed supporting literature” — its authors acknowledge that no randomised trial supports the practice, and that virtually all of the evidence base is single-centre observational.
A formal European consensus document of equivalent standing does not exist. The European Society of Thoracic Surgeons has published surveys of practice (Internullo 2008; van Dorp 2023) and a 2019 database report on perioperative outcomes (Gonzalez 2021), but these describe what European thoracic surgeons do rather than what they collectively recommend. The most recent ESTS survey, published in 2023, found that 92% of responding European thoracic surgeons believe metastasectomy improves survival in colorectal cancer and 97% believe it improves disease control — but acknowledges that this is opinion, not evidence.
This is the honest current state of the field. The practice is widely performed, internationally endorsed by a US expert consensus, descriptively documented in European registries, and contested by a published critique that no defender has been able to refute on the strength of trial evidence. The flagship clinical work continues, with patient selection as the discipline that holds the practice together.
The four prognostic factors identified by Pastorino in 1997 remain the framework: expectation of complete resection — if the imaging and surgical assessment cannot offer reasonable confidence of clearing all visible disease, the operation is not appropriate; disease-free interval since primary treatment — a longer interval is a favourable prognostic feature; number of metastases — limited disease is the broadly accepted threshold, with quantification deferred to MDT discussion in each case; and histology — the same number of metastases means different things in different cancers.
In Mr Okiror’s practice, the typical criteria the MDT considers before recommending metastasectomy are these — bearing in mind that this list is not exhaustive, and every case is decided by the multidisciplinary team rather than by criteria alone:
1. Limited number of lung metastases. The threshold is not a fixed number. It is the number that the surgeon can reasonably expect to clear completely, with sufficient lung function preserved for the patient to live well afterwards. Quantification is deferred to the MDT discussion in each case.
2. Primary cancer treated or under control. Surgery on lung metastases is futile if the primary disease is uncontrolled. Verification comes from the primary oncology team’s records and current imaging.
3. Patient is well enough to tolerate surgery. Standard fitness assessment, including lung function reserve, cardiac assessment, and performance status. The patient must have the physiological reserve to recover well. Patients sometimes deemed unfit elsewhere are re-assessed against the structured pre-operative pathway set out on the fitness for lung surgery page; in a meaningful proportion the original verdict is revised once V/Q SPECT-CT, CPET, and split-function calculations are in hand.
4. No extra-thoracic disease, with the exception of colorectal liver metastases. Lung-only disease is the typical setting. The recognised exception is colorectal cancer with controllable liver and lung metastases — a coordinated pathway described separately below.
5. Surgery is deemed the best treatment option by the MDT. Local ablation (radiofrequency, microwave), stereotactic radiotherapy (SABR), and continued systemic therapy are considered. Surgery is recommended only when the MDT judges it the most appropriate option for the specific patient and the specific disease pattern.
Patients with both liver and lung metastases from colorectal cancer are managed individually through joint discussion between the colorectal MDT, hepatobiliary, and thoracic teams. The two surgical episodes are sequenced, not combined. Most often the liver disease is treated first, with the lung surgery following once liver clearance is established and the patient has recovered. In a smaller subset, the lung surgery is performed first. The sequence is determined by disease distribution, primary control, technical considerations on each side, and patient fitness — not by a fixed protocol. Synchronous combined liver-and-lung surgery is not part of the practice.
This sequenced approach reflects the recognition that operating on both sites within the same hospital admission carries cumulative morbidity that is typically avoidable by separating the operations in time, and that the interval allows imaging to confirm that no new disease has appeared on the unoperated side before the second procedure proceeds.
Lung metastases can arise from almost any solid cancer. Surgical practice varies substantially across tumour types, reflecting differences in biology, the availability of effective systemic treatment, and the strength of the supporting clinical evidence. Mr Okiror’s practice mirrors that variation.
Colorectal cancer is the largest single group of patients undergoing pulmonary metastasectomy, in Mr Okiror’s practice and in UK thoracic surgery generally. Lung metastases develop in approximately 10–15% of patients treated for colorectal cancer, and a meaningful fraction of those have disease that is limited and resectable.
The CRC-specific evidence base, beyond the general metastasectomy literature, includes Gonzalez and colleagues’ 2013 systematic review and meta-analysis in the Annals of Surgical Oncology — which pooled 25 studies and 2,925 patients and identified four poor-prognosis factors after CRC pulmonary metastasectomy: short disease-free interval (HR 1.59), multiple lung metastases (HR 2.04), elevated pre-operative carcinoembryonic antigen (HR 1.91), and hilar or mediastinal lymph node involvement (HR 1.65).
These factors are weighed at the colorectal MDT and at the surgical decision. Patients are referred to Mr Okiror by colorectal MDTs across London and the South East, with district MDTs across Kent — including Darent Valley — sending patients directly into the GSTT and London Bridge Hospital pathways.
A second tier of cancers reaches metastasectomy through specialist MDT pathways, after the primary oncology team has delivered systemic treatment. These are established surgical practice — neither novel nor experimental — but the volume in any individual surgeon’s practice is smaller than colorectal, and the systemic-treatment-first sequencing is non-negotiable.
Breast cancer. Selected patients with limited lung metastases, after systemic and endocrine treatment, are referred by their breast MDT. A distinctive subset is described in the internal mammary node callout below.
Gynaecological cancers. Ovarian and uterine cancers occasionally develop limited lung metastases that are appropriate for surgical removal after the primary oncological treatment is complete.
Upper gastrointestinal cancers. Oesophageal and gastric cancers occasionally produce lung metastases that meet selection criteria, typically after curative-intent treatment of the primary tumour.
In each case, several patients across each group have been managed in Mr Okiror’s practice. The framing on this page is qualitative — “selected cases” and “a number of patients” — not because the work is rare but because the page is descriptive of practice rather than promotional of volume.
Internal mammary lymph nodes lie inside the chest wall, alongside the sternum, and are difficult to access by any non-robotic approach. In carefully selected patients with breast cancer, post-systemic-treatment, where the disease pattern is limited to the internal mammary chain, robotic resection is technically feasible and well-tolerated.
Patients reach this operation through specialist breast MDTs across London and Kent. The operation is not appropriate as a routine treatment for nodal metastatic breast cancer — it is offered in a specific and unusual clinical configuration where the nodal disease is the dominant problem, the primary disease is controlled, and the patient and the breast oncology team agree that local control of the IMC disease is worth pursuing surgically. The robotic platform genuinely works well for this anatomy.
If you are a breast oncologist with a patient who may meet these criteria, contact the practice for case discussion →
A third tier of cancers reaches metastasectomy in carefully selected, MDT-anchored cases. Numbers are smaller and decisions more individualised: renal cell carcinoma — lung is a common site of metastasis, and surgery is appropriate in selected patients with limited disease, particularly those whose primary tumour was treated some years previously; head and neck cancer — selected cases, MDT-led, after primary control; melanoma — the systemic treatment landscape has changed substantially with checkpoint inhibitors, and surgical metastasectomy is occasionally appropriate in selected patients in modern combination pathways; germ cell tumours — the most chemo-curable of metastatic cancers, with surgery occasionally indicated for residual masses after chemotherapy, managed in close collaboration with the testicular cancer oncology team.
Sarcoma is a separate clinical pathway. National commissioning for sarcoma surgical care in England routes thoracic surgical resection to Royal Brompton Hospital, with sarcoma oncology and diagnosis provided through the London Sarcoma Service (the Royal Marsden, the Royal National Orthopaedic Hospital, and University College London Hospitals). Patients with suspected or confirmed sarcoma metastases to the lungs should be referred through that pathway rather than to Mr Okiror’s practice.
Mr Okiror’s first-author paper on sarcoma metastasectomy was published in the Thoracic and Cardiovascular Surgeon in 2016, drawn from his training period at Birmingham Heartlands Hospital with Professor Robert Grimer; that academic engagement with the sarcoma metastasectomy literature does not translate into a current sarcoma service. Sarcoma cases are referred onward. This is the right routing under national commissioning, and patients are better served by the dedicated sarcoma pathway than by metastasectomy outside it.
The surgical approach to a pulmonary metastasectomy depends on three things: where the metastasis is in the lung, how many metastases there are, and how much healthy lung needs to be preserved for the patient’s future.
In Mr Okiror’s practice, the great majority of metastasectomy is performed by minimally invasive technique — robotic resection using the da Vinci Xi platform, or VATS keyhole resection through small incisions between the ribs. A small selected subset of patients with deep parenchymal lesions, where preserving lung reserve across multiple resections matters most, are operated on through a small thoracotomy with laser-assisted parenchymal preservation. The choice between approaches is driven by the anatomy of the metastasis, not by surgeon preference for one technique over another.
| Metastasis location | Surgical approach | Typical stay |
|---|---|---|
| Peripheral — at the edge of the lung | VATS or robotic wedge resection through three small incisions | 1–2 days |
| Deeper-seated — within parenchyma but not central | Limax 1318 nm laser metastasectomy through a small thoracotomy, with parenchymal preservation | 2–3 days |
| Central — close to airway or major vessels | Robotic anatomical segmentectomy or, where unavoidable, lobectomy | 3–5 days |
These are typical lengths of stay, not contractual minimums. Recovery varies between patients; some go home faster and some need an additional day for fluid balance, drain management, or pain control. The numbers are useful for planning purposes — they answer the practical question patients actually ask.
For deep-seated metastases — lesions that are not at the lung edge and that would otherwise require a wedge resection sacrificing a substantial volume of healthy parenchyma — laser metastasectomy is a parenchyma-preserving alternative. The technique uses a Class 4 1318 nm Nd:YAG laser (Limax 120, KLS Martin, Tuttlingen, Germany) to enucleate the metastasis from within the surrounding lung tissue while creating a coagulation rim of approximately five millimetres at the resection bed.
The technique was developed by Axel Rolle’s group in Coswig, Germany, with the first 100-patient series published in the Annals of Thoracic Surgery in 2002. Subsequent work from Coswig (a 328-patient series in 2006) and from other European centres has demonstrated that 1318 nm laser metastasectomy achieves complete resection rates comparable to staple wedge while preserving substantially more healthy parenchyma — particularly in patients with multiple, bilateral, or centrally placed metastases. A 2024 follow-up study from the Coswig database of 4,595 patients demonstrated complete recovery of lung function at twelve months following laser metastasectomy.
The clinical claim made for laser metastasectomy is parenchymal preservation, not oncological superiority. The published evidence supports the lung-preservation claim. It does not establish that laser resection produces better cancer outcomes than staple wedge resection — and the page does not make that claim. The advantage of preservation matters most where it compounds across episodes: a patient who may need further surgery in future has more lung available at the second operation if the first was performed with maximum preservation.
Mr Okiror leads laser metastasectomy at Guy’s and St Thomas’ and London Bridge Hospital, working under the Class 4 laser governance protocols he authored in 2021.
The decision to perform laser metastasectomy through a small thoracotomy rather than VATS reflects the technique’s requirement for direct bimanual palpation of the lung — which allows identification of small lesions that may not be visible on intraoperative imaging — and for precise control of the laser beam at the parenchymal interface. The thoracotomy is small, with rib-spreading minimised, and the typical length of stay (2–3 days) reflects the preserved-parenchyma physiology rather than the conventional open-thoracotomy recovery profile.
When metastases are present in both lungs, they are not operated on as a single bilateral procedure. Each side is treated as a separate keyhole or robotic operation, with 3 to 5 weeks between the two episodes. Between operations, an interim CT scan is performed to confirm that no new disease has emerged on the unoperated side and to inform the second-side surgical plan.
This staged approach has three advantages over a single bilateral operation. It is technically simpler — each side is operated on through optimal minimally invasive access. It is physiologically gentler — the patient recovers from one side before the other is undertaken. And it preserves the option to revise the second-side plan if the disease has changed in the interval, which it occasionally has.
A number of patients in Mr Okiror’s practice have undergone more than one metastasectomy episode. New lesions develop in some patients despite a successful first resection, and where the patient remains well, the disease remains limited, the primary cancer remains controlled, and the MDT agrees, repeat surgery can usually be offered.
The rationale for repeat metastasectomy parallels the rationale for the first operation — selection criteria are reapplied, fitness is reassessed, and the MDT discussion is repeated. The pooled literature on repeat colorectal metastasectomy (Salah and colleagues, 2013) reports five-year survival of approximately 57% in selected patients undergoing repeat resection, broadly consistent with first-time outcomes in similar patient profiles.
Patients are usually relieved to know that repeat surgery is feasible. A common worry — voiced explicitly or carried silently into clinic — is that any further disease would mean the end of treatment options. It does not. Mr Okiror is open with patients about this from the first consultation, and the laser-preservation approach is part of the same logic: every gram of healthy lung preserved at the first operation is lung available for a second or third operation if needed.
Repeat surgery is decided case by case. The technical considerations differ from the first operation — adhesions from the previous surgery can complicate access, and the residual lung anatomy informs the approach. These are surmountable in most cases.
Most patients are referred to Mr Okiror by the multidisciplinary team caring for their primary cancer. A colorectal MDT, breast MDT, gynae-oncology MDT, or upper GI MDT considers a patient with developing lung metastases, agrees that surgical metastasectomy is the best option, and refers the patient to a thoracic surgeon. That referral is the formal entry into the pathway, and it carries the implicit endorsement of the primary tumour MDT — the team that knows the cancer, the systemic treatment history, and the patient’s broader oncological trajectory.
Patients who self-refer privately are routed through the London Bridge Hospital chest MDT before any surgical decision is made. This means a patient who reads about metastasectomy, contacts the practice directly, and meets Mr Okiror in clinic does not progress to surgery on the basis of one private consultation. The case is presented to the LBH chest MDT — including specialist oncologists, radiologists, pathologists, and respiratory physicians — and the MDT decision is the surgical decision. This safeguards against private consultation becoming a route around multidisciplinary governance.
The LBH chest MDT is attended fortnightly by Mr Okiror. Cases discussed there receive the same multidisciplinary input as patients at Guy’s and St Thomas’, drawing on consultant oncologists in private practice, specialist thoracic radiologists, and the wider chest physician network at London Bridge Hospital.
For each candidate patient, the MDT looks at: the primary cancer history — when it was diagnosed, how it was treated, current control; current imaging — CT thorax, abdomen and pelvis at minimum, PET-CT in most cases, MRI of the brain if indicated; the number, size, and location of lung lesions; lung function and cardiac fitness for surgery; any extra-thoracic disease and the colorectal liver-and-lung exception; the systemic treatment plan — whether further chemotherapy, immunotherapy, or targeted therapy is planned before or after surgery; and patient preferences, including, where relevant, the patient’s view on the uncertainty discussed earlier.
The MDT decision is documented and communicated back to the referring team and the patient. Where surgery is recommended, a date is offered. Where surgery is not recommended, the alternative — local ablation, stereotactic radiotherapy, continued systemic treatment, or surveillance — is set out clearly.
Mr Lawrence Okiror’s NHS practice is at Guy’s and St Thomas’ NHS Foundation Trust — a large-volume thoracic surgical centre with over 2,000 thoracic operations in 2024–25, the highest annual volume in the UK. He is Clinical Audit Lead for Thoracic Surgery at the Trust.
Private metastasectomy is performed at London Bridge Hospital and The Lister Hospital Chelsea. Both hospitals hold the da Vinci Xi robotic surgical platform and have the theatre infrastructure for keyhole and robotic resection. London Bridge Hospital is the primary base for complex cases, multimodality care, and patients whose pathway involves diagnostic bronchoscopy or coordination with the LBH chest MDT. The Lister is the second operating base for straightforward robotic and keyhole resections, suitable for many patients depending on convenience and case complexity.
Outpatient consultations are also available at the HCA clinics in Canary Wharf (40 Bank Street) and the City of London (Old Broad Street). Surgery and overnight care take place at London Bridge Hospital or The Lister Chelsea.
Most private patients are seen within 2 to 3 days of contacting the practice. No GP referral is required — patients may self-refer directly. For patients moving from NHS to private care, scan images and reports are reviewed at the first appointment. Initial consultations are from £250. Where ongoing diagnostic or surgical care is needed, transparent estimates are provided in advance by Jo Mitchelson, Mr Okiror’s PA, before any commitment is made.
Mr Okiror is recognised by all major UK private medical insurers including AXA, BUPA, WPA, Vitality, Cigna, and Aviva. Self-pay patients are equally welcome. Pre-authorisation and cost transparency are arranged in advance through Jo on 020 7952 2882.
For patients who have been seen elsewhere and want an independent review of their imaging, pathology, MDT decision, and surgical recommendation before committing to a treatment plan, Mr Okiror offers a comprehensive second-opinion service. Most second-opinion appointments are available within 2 to 3 days of referral. Request a second opinion →
Indication is MDT-led. Patients are referred by their primary tumour multidisciplinary team. Self-referrals are routed through the London Bridge Hospital chest MDT before any surgical decision.
Selection criteria, broadly. Limited number of lung metastases; primary cancer treated or under control; patient fit for surgery; no extra-thoracic disease, with the recognised exception of colorectal liver metastases; the MDT agrees surgery is the best option. Typical, not exhaustive — every case is decided by the MDT, not by criteria alone.
The evidence position is not settled. PulMiCC was inconclusive. The field is divided. Mr Okiror’s position: the evidence is neither strong enough to refute nor confirm the efficacy of metastasectomy, and patients are entitled to that honesty.
Surgical approach. The great majority of metastasectomy is performed robotically or by VATS keyhole. A small selected subset undergo small-thoracotomy laser metastasectomy for deep parenchymal preservation. Mr Okiror leads laser metastasectomy at Guy’s and St Thomas’ and London Bridge Hospital under the Class 4 laser governance protocols he authored in 2021.
Length of stay. Peripheral robotic or VATS wedge 1–2 days; small-thoracotomy laser metastasectomy 2–3 days; central robotic segmentectomy or lobectomy 3–5 days.
Bilateral disease. Each side is operated on as a separate procedure, 3–5 weeks apart, with interim CT.
Repeat surgery is feasible in selected patients. A number of patients in Mr Okiror’s practice have undergone more than one metastasectomy episode.
Tumour types. Colorectal cancer is the largest single group. Breast, gynaecological, and upper GI cancers in selected MDT-referred cases. Renal, head and neck, melanoma, and germ cell in selected cases. Sarcoma is referred onward to the London Sarcoma Service and Royal Brompton Hospital.
What evidence supports lung metastasectomy?
The evidence base is observational rather than randomised. The foundational dataset is the International Registry of Lung Metastases, published in 1997, which pooled outcomes on 5,206 patients across 18 international centres and identified the four prognostic factors that have shaped patient selection for the three decades since: completeness of resection, disease-free interval, number of metastases, and histology. The PulMiCC randomised trial recruited 93 patients against a target of around 1,500 and was inconclusive. The honest summary is that the evidence is neither strong enough to refute the efficacy of metastasectomy nor strong enough to confirm it, and Mr Okiror is open with every patient about that uncertainty.
Which tumour types are appropriate for referral?
Colorectal cancer is the largest single group. Breast, gynaecological (ovarian, uterine), and upper GI (oesophageal, gastric) cancers are referred in selected cases by their respective specialist multidisciplinary teams, after systemic treatment. Renal cell carcinoma, head and neck cancer, melanoma, and germ cell tumours are seen in selected MDT-led cases. Sarcoma is referred onward to the London Sarcoma Service for oncology and to Royal Brompton Hospital for thoracic surgical resection.
How is the surgical approach decided?
Peripheral lesions at the edge of the lung are typically removed by VATS or robotic wedge resection (1–2 day stay). Deeper-seated parenchymal lesions are addressed by Limax 1318 nm laser metastasectomy through a small thoracotomy (2–3 day stay). Central lesions close to the airway or major vessels are managed by robotic anatomical segmentectomy or, where unavoidable, lobectomy (3–5 day stay). The vast majority are robotic or VATS keyhole; a small selected subset are small-thoracotomy laser metastasectomy.
When is laser metastasectomy preferred?
Laser metastasectomy is preferred for deep-seated parenchymal lesions where a wedge resection would sacrifice substantial healthy lung. The clinical claim is parenchymal preservation, not oncological superiority — the published evidence does not establish better cancer outcomes than staple wedge, but does establish more healthy lung is preserved. Mr Okiror leads laser metastasectomy at Guy’s and St Thomas’ and London Bridge Hospital under the Class 4 laser governance protocols he authored in 2021.
How is bilateral disease managed?
Each side is operated on as a separate keyhole or robotic procedure, with 3 to 5 weeks between operations. An interim CT scan is performed in that window to confirm no new disease and to inform the second-side plan. The staged approach is technically simpler, physiologically gentler, and preserves the option to revise the second-side plan if disease has changed.
What is the role of repeat metastasectomy?
In selected patients who develop new lung metastases after a successful first resection, repeat surgery can usually be offered. Selection criteria are reapplied. The pooled literature on repeat colorectal metastasectomy reports five-year survival of approximately 57% in selected patients. A number of patients in Mr Okiror’s practice have undergone more than one metastasectomy episode.
Where are sarcoma lung metastases referred?
Sarcoma is a separately commissioned pathway in England. Sarcoma oncology and diagnosis are provided by the London Sarcoma Service — the Royal Marsden, the Royal National Orthopaedic Hospital, and University College London Hospitals. Thoracic surgical resection of sarcoma lung metastases is commissioned to Royal Brompton Hospital. Patients with suspected or confirmed sarcoma should be referred through that pathway.
Can lung surgery help patients with breast, ovarian, uterine, oesophageal or gastric cancer that has spread to the lungs?
Yes, in selected cases, after the primary oncology team has delivered systemic treatment and the relevant specialist multidisciplinary team agrees that surgery is appropriate. The evidence base for non-colorectal lung metastasectomy is observational, smaller than the colorectal evidence base, and the principles of patient selection apply with at least the same rigour. Mr Okiror works with breast, gynae-oncology, and upper GI MDTs across London and Kent.
What is internal mammary node resection in breast cancer?
Internal mammary lymph nodes lie inside the chest wall, alongside the sternum, and are difficult to access by any non-robotic approach. In carefully selected breast cancer patients, post-systemic-treatment, where the disease pattern is limited to the internal mammary chain, robotic resection is technically feasible and well-tolerated. It is offered where the nodal disease is the dominant problem, the primary disease is controlled, and the breast oncology team agrees that local surgical control is worth pursuing. Patients reach this operation through specialist breast multidisciplinary teams across London and Kent.
Mr Okiror sees private patients within 2–3 working days at London Bridge Hospital and The Lister Hospital Chelsea. NHS referrals through Guy’s and St Thomas’. Self-referrals are routed through the LBH chest MDT before any surgical decision. Second opinion service available within 2–3 days for patients seen elsewhere.
Request a consultation →Disclosures
This guide describes Mr Lawrence Okiror’s clinical practice in pulmonary metastasectomy as of May 2026. It is intended as patient and referrer information, not as medical advice for any individual case. The page does not invite self-referral as a surgical pathway: patients referred by their primary tumour MDT enter the surgical pathway directly; patients who contact the practice without a primary MDT referral are routed through the London Bridge Hospital chest MDT before any surgical decision is made. The evidence base for pulmonary metastasectomy is observational rather than randomised. The PulMiCC trial, the only randomised trial in the field, did not recruit to target. Critics argue that the magnitude of survival benefit attributed to surgery in observational series is overstated by patient selection. Mr Okiror’s position is that the evidence is neither strong enough to refute the efficacy of metastasectomy nor strong enough to confirm it, and patients are entitled to that honesty. Mr Okiror has no commercial relationship with KLS Martin or any laser device manufacturer. He authored the GSTT Class 4 laser governance protocols in 2021 in his capacity as the institution’s lead laser metastasectomy operator.
Plain-English orientation for patients and families — what it means and when surgery can help
Shadow Found on Lung ScanFor patients who have just been told a CT shows shadows on the lung — what it means and what comes next
Robotic SegmentectomyAnatomical lung-sparing resection — the operation used for central metastases requiring more than wedge resection
Robotic Lung SurgeryThe full robotic thoracic surgery service — technique, evidence, and outcomes
Lung Nodule Precision PathwayFrom scan review through biopsy to surgery — the integrated private pathway
Specialist Second OpinionIndependent review for patients seen elsewhere — within 2–3 days
Lung Cancer Surgery in 2026Companion flagship: surgery for primary lung cancer, distinct from metastasectomy
Fitness for Lung SurgeryPre-operative assessment for patients told they are unfit for surgery elsewhere