Lung Cancer: Surgery
Surgery is often part of the treatment for some early-stage lung cancers. Unfortunately,
many lung cancers have already spread too far to be treated with surgery by the time
they are found.
If surgery is a choice of treatment, different kinds of operations may be done. Which
type you have depends on several things, including where the cancer is and how large
it is.
When might surgery be used for lung cancer?
You are more likely to have surgery if you have non-small cell lung cancer (NSCLC)
instead of small cell lung cancer (SCLC). This is because SCLC usually has already
spread when it's found.
You have to be healthy enough to have surgery for it to be a good choice for you.
If you have heart disease, your lung cancer surgeon may ask your heart healthcare
provider to give approval for your surgery. If you have emphysema or any other type
of lung disease, you will likely need pulmonary function tests before surgery. This
is to make sure you will have enough lung function remaining after surgery.
Non-small cell lung cancer
Surgery is a common treatment for NSCLCs that haven't spread to other parts of the
body. Surgery often offers the best chance to cure the cancer. When surgery is done,
it is often used along with other forms of treatment, such as chemotherapy or radiation
therapy.
NSCLC that has spread to other parts of the body is not often treated with surgery.
A possible exception is if the cancer has spread as a single tumor to only one other
spot, such as the brain or an adrenal gland. In this case, surgery may be done if both
the cancer in the lung and the tumor in the other organ can be removed.
Small cell lung cancer
You are less likely to have surgery to treat SCLC, unless it is very small and only
in nearby lymph nodes. Unfortunately, very few SCLCs are found at such an early stage
before it spreads.
Types of surgery for lung cancer
The type of lung surgery you have depends on your health, extent (stage) of the cancer,
and location of the tumor. The healthcare provider may remove part or all of the affected
lung. The following are the main types of lung surgery. For these operations, the
surgeon usually makes a cut (incision) in the side of the chest and reaches the lung
between the ribs. This is called a thoracotomy.
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Lobectomy. Each lung is divided into sections called lobes. The right lung has three lobes and
the left lung has two lobes. This type of surgery removes only the lobe of the lung
that the cancer is in, often along with some of the nearby lymph nodes. This is the
most common surgery done for lung cancer that’s only in one lobe of the lung.
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Wedge resection or segmentectomy. With a wedge resection, your surgeon takes out only the tumor itself and a small
part of lung around it, not the entire lobe. With a segmentectomy, the surgeon takes
out a slightly larger part of the lung. These types of surgery are typically done
in people who can't tolerate more extensive surgery, such as a lobectomy. For instance,
if you have emphysema, your lungs won’t expand well after a lobectomy. The chances
of the lung cancer coming back are higher with these types of surgery than with a
lobectomy.
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Pneumonectomy. During this surgery, the entire lung that is affected is removed. Surgeons only do
a pneumonectomy if the tumor can't be completely removed with a lobectomy.
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Sleeve resection. This surgery is sometimes used if the cancer is in a large airway (bronchus) near
where it enters the lung. The section of the bronchus containing the cancer is removed.
The lung is reattached to the remaining bronchus. This allows the surgeon to stay
away from having to remove the whole lung.
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Video-assisted thoracic surgery (VATS). This is a less invasive procedure for treating early-stage lung cancer, especially
for smaller tumors near the outside of the lung. Instead of making a large incision
(thoracotomy), the surgeon places a thin tube with a small video camera on the end
through a small opening in the side of the chest. The surgeon makes two or three other
small openings in the chest to insert tools to remove the tumor. This procedure often
involves less pain after surgery and a shorter hospital stay. VATS should be done
by a surgeon who has experience with this method.
Risks and possible side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Along with the risks above, lung surgery can sometimes cause:
Getting ready for your surgery
Before you have surgery, you will talk with your surgeon. After you have talked about
all the details of the surgery, you will sign a consent form. This gives the surgeon
permission to do the surgery. Consider having a family member or close friend with
you when you ask your questions. Make sure all of your questions are answered before
you sign the form.
Also consider completing an advance directive. This is a legal document that tells
your healthcare providers and family members how you want medical decisions made if
you can't make them for yourself. An advance directive doesn't involve financial or
money matters. It only applies to healthcare decisions.
You will also talk with an anesthesiologist. This is the healthcare provider who will
give you general anesthesia, the medicine that prevents pain and makes you sleep during
surgery. They also keep track of you during surgery to keep you safe. They will ask
about your health history, past history with anesthesia, and your medicines. You will
sign a consent form for anesthesia to be given.
Follow any instructions for not eating or drinking before surgery. Also ask if you
should stop taking some or all of your medicines before surgery. Tell your healthcare
team about all of the prescription medicines, over-the-counter medicines, and supplements
that you take.
What to expect during surgery
On the day of surgery, you will be taken into the operating room. Your healthcare
team will include the anesthesiologist, the surgeon, and nurses.
During a typical surgery:
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You will be moved onto the operating table.
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You may need to wear special stockings on your legs. These are to help prevent blood
clots.
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You will have electrocardiogram electrodes put on your chest. These are to keep track
of your heart rate.
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You will also have a blood pressure cuff on your arm.
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You will be given anesthesia through an IV in your hand or arm.
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When you are asleep, the surgeon will do the surgery.
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A urinary catheter will be put into the bladder during surgery. It will be kept in
place for at least a few days.
What is removed during surgery and where your incisions are depend on the type of
surgery you have.
What to expect after surgery
You will be taken to the post anesthesia care unit where you will be closely watched
by healthcare providers as you wake from anesthesia. You will be given medicine as
needed to treat pain. You may have one or more tubes in your chest to drain fluid
and air. Your healthcare team will let you know when they can be removed. You will
likely stay in the hospital for several days. How long you stay will depend on the
type of surgery you have. People who have VATS can often go home sooner than those
who have a thoracotomy. This is because they have smaller incisions that can often
heal faster.
After surgery you will have follow-up appointments with your surgeon and other healthcare
providers. Make sure to keep your appointments. If you have any problems or concerns,
contact your healthcare team.
You may get chemotherapy, radiation therapy, immunotherapy, targeted therapy or a
combination of these after your surgery as part of your treatment. The goal is to
make it less likely that any cells that may remain won’t spread. Having another type
of treatment soon after surgery is called adjuvant therapy.