Surgery for Lung Cancer

Lung cancer surgery is a medical procedure for removing tumors from the lungs and other nearby organs, such as the lymph nodes. It can be an effective means of treating lung cancer but is a major operation with a lengthy recovery period and potentially serious side effects. Lung cancer surgery is most appropriate for treating localized cancers prior to their spread to other parts of the body. It is best utilized in treating non-small cell varieties of lung cancer, because small cell lung cancer has usually metastasized, or spread, by the time it’s been diagnosed.

What Types of Lung Cancer Surgery Are There?

There are several types of lung-cancer surgery, depending on the cancer’s type, location, stage, and the patient’s general health condition. The most common approach is called a thoracotomy, or large-incision surgery. This involves your surgeon making a long cut in your back and side muscles, following the curve of the ribs, and removing the diseased tissue and some surrounding healthy tissue as well. Large-incision surgery can be a standalone procedure for treating lung cancer, or employed in combination with radiation and/or chemotherapy.

Thoracotomies come in four versions, based on the volume of lung removed from the body:

• Sleeve resection: Sleeve resections target tumors that have formed in the lung’s airways. The tumors and any adjacent tissues are removed by your medical team. This type of surgery leaves intact most of the lung’s healthy tissue.
• Segmentectomy or wedge resection: Human lungs are divided into five parts or lobes – two on the left and three on the right. Segment or wedge surgeries target localized cancers in portions of a single lobe. Resections are ideal for persons whose pulmonary health has been compromised to the extent that they can’t afford to lose an entire lobe. The associated risk is that some of the cancer may be left behind.
• Lobectomy: A lobectomy is the surgical removal of an entire lobe. Lobe removal is viewed as the best form of surgery for treating a non-small cell lung cancer.
• Pneumonectomy: A pneumonectomy is the surgical removal of entire lung. This is an option for a relatively large tumor or one that is located near chest center.

Minimally Invasive Surgery

Minimally invasive surgery is an increasingly popular alternative to thoracotomy. The surgeon gains access to the lungs through a series of small incisions rather than through a single large one. Minimally invasive surgery is proving effective in treating cancers in the early stages of development, with less post-surgical pain and quicker recovery times. It may not, however, be appropriate for more advanced cases of the disease.

There are two primary forms of minimally invasive surgery for lung cancer:

• Video-assisted Thoracic Surgery (VATS): VATS proceeds by cutting two or three small incisions in the chest cavity. One incision allows insertion of a tiny video camera, the other, surgical tools. The camera transmits pictures of the surgical site to a TV monitor, which provides the surgeon with the visual contact he or she needs to conduct the operation.
• Robot-assisted surgery: Robot-assisted surgery is similar to VATS, but is conducted by means of robotic arms, which the surgeon operates remotely.

What Should I Expect from Lung Cancer Surgery?

Not every person with lung cancer is a good candidate for surgery. Your oncologist (cancer specialist) will determine the best course of treatment, based on the type, stage, and location of your cancer. Surgery is generally an option in those situations where the cancer is localized and early in development (stages 1, 2, and 3A for non-small cell lung cancer). You will also undergo a physical exam, with tests of your lung capacity and other vital systems. These will be further indicators of the surgical procedure that best suits your condition.

There are several things you can do to prepare for your procedure:

• Quit smoking: Tobacco is hard on the lungs. You’ll heal faster if you’re not a smoker.
• Talk to your physician about any medications you’re taking: Some of them might be contraindicated prior to surgery.
• Plan for recovery: You’ll need time to recuperate from lung cancer surgery. Put a plan in place with your family and friends to care for you while you’re on the mend.
• Consider pulmonary rehab: Losing part of your lung means a reduction in your ability to breathe. Exercises to rebuild your pulmonary capacity can be crucial to feeling better and returning to a normal routine.

Expect to spend several days in the medical facility where the procedure takes place. You won’t be able to eat or drink anything immediately prior to surgery. You’ll receive a general anesthetic beforehand, so you won’t be awake during the procedure itself.

Recovery time for lung surgery can measure in weeks or months. You will likely experience some pain, especially if you’ve undergone a thoracotomy. Your physician will prescribe medications to limit your discomfort. Many lung-cancer patients find that they can resume day-to-day activities after a period of healing and adjustment.

What Are the Potential Side Effects of Lung Cancer Surgery?

Though often effective in treating the disease, lung cancer surgery is also linked to serious medical side effects, including:

• Excessive bleeding
• Blood clots in the lungs or legs
• Adverse reactions to anesthesia
• Incision infections
• Pneumonia
• Lung collapse (pneumothorax)
• Damage to nearby organs, especially the heart.

Lung cancer surgery can, in rare cases, result in death.