Lung Cancer Surgery: What You Need To Know

Lung cancer is the third most common cancer in the United States. It's also cancer with the highest mortality rate¹. According to the American Cancer Society², about 235, 760 cases of lung cancer will be diagnosed in 2021.

Surgery is the preferred treatment method for early-stage non-small cell lung cancer. When this type of cancer is caught early, operations have a high success rate. Patients with late-stage lung cancer are rarely suitable for surgery.

Learning about lung cancer surgery options, possibilities, and outcomes can help you make decisions about the course of lung cancer treatment.

What is lung cancer surgery?

Lung cancer surgery is one of the treatment options for lung cancer patients. It can involve removing a portion of the lung or the entire lung. The feasibility of such an operation depends on the stage, location, and type of lung cancer.

Types of lung cancer surgery

The type of lung cancer surgery an oncologist may recommend depends on several factors, including:

• Type of lung cancer (small cell or non-small cell)

• The location of cancer in the lung

• If cancer has spread outside the lung

Lung cancer surgery is rarely recommended to patients with small cell cancer. When this type of lung cancer is diagnosed, it has usually spread beyond the lung and requires another treatment approach. When the small cell cancer is a solitary nodule without distant metastasis or regional lymph node involvement, it can be operated on.

Surgery is often highly recommended for early-stage non-small cell lung cancer since it provides the best chance to cure the disease.

Lobectomy

Lungs consist of five lobes (three lobes in the right lung and two lobes in the left lung). A lobectomy involves removing one of these lobes. A surgeon usually recommends this type of surgery when cancer is localized in one lobe.

A lobectomy is the most common type of lung cancer surgery.

Limited (sublobar) resection

This type of surgery involves removing one or more anatomical segments of the lobe (segmentectomy) or, more often, a non-anatomic smaller portion of the lobe (wedge resection). It may be recommended when the patient doesn't have sufficient lung function to handle a lobectomy or in carefully selected patients with very small peripheral stage I non-small cell lung cancer.

Sleeve resection

This surgery removes the tumor from a lung lobe as well as from a part of the main airway. A surgeon may recommend this operation if cancer involves the origin of a bronchus but is still restricted to one lobe.

Pneumonectomy

Pneumonectomy is the removal of the entire lung. This surgery is recommended if a lobectomy can't remove the entire tumor or if cancer is in the central area of the lung.

While each case is unique, a lobectomy is generally accepted as the optimal treatment for early-stage non-small cell lung cancer. When the tumor is central and cannot be removed by lobectomy, a sleeve resection is preferred over pneumonectomy if possible, as it usually provides similar results while preserving the pulmonary function better and avoiding the complications of a pneumonectomy.

How lung cancer surgery is performed

To remove lung cancer, a surgeon can choose one of several approaches:

Open surgery (Thoracotomy)

Open surgery involves making an incision on the side of your chest and gently pushing muscles and ribs apart to gain direct access to the lungs.

Minimally invasive surgery (VATS and RATS)

VATS (Video-Assisted Thoracoscopic Surgery) involves making several small incisions in the side of the chest. The surgeon pushes a small tube with a camera attached to it through the incision to get a video feed of the lung. Then they use special instruments to remove the tumor through the incisions.

Another way to perform this surgery is to use a robotic system – RATS (Robotically Assisted Thoracic Surgery). During this surgery, a surgeon remotely controls robotic arms that perform the operation through the small incisions in the chest.

Open surgery usually lasts between two and six hours. VATS or RATS can last between two and three hours.

Goals of lung cancer surgery

The main goal of lung cancer surgery is to remove as much cancer as possible. In the early stages of lung cancer, it's often possible to eliminate it completely.

Other goals of lung cancer surgery include:

• Removing lymph nodes to check them for cancer.

• Removing tumors for patients with metastasized cancer to relieve the symptoms.

In many cases, surgery for lung cancer increases the survival rate for the patient. Patients with stage IV disease are generally treated with systemic therapy or a symptom-based palliative approach. A recent study³ showed that even patients with stage IV non-small cell lung cancer could benefit from surgery in addition to systemic therapy.

Risks of lung cancer surgery

Lung cancer surgery is a major operation that comes with several risks, including:

• Allergic reactions to the anesthesia

• Excessive bleeding

• Blood clots in legs that may travel up to the lungs

• Incision site infections

• Pneumonia

About 20% of lung cancer surgeries⁴ lead to some complications. In rare cases, patients don't survive the surgery.

The possibility of surgery side effects also depends on how healthy you are before the surgery and how well you prepare for it. Talk to your doctor about risks that you are most susceptible to.

What to expect before lung cancer surgery

Before lung cancer surgery, you need to go through some testing which may include:

• Blood and urine tests

• Chest x-ray

• ECG (test to check your heart's rhythm)

• Lung function tests

• Scans

If you are a smoker, it's important to quit a few weeks before the surgery. This can reduce the risk⁵ of facing breathing problems and other complications during the surgery as well as helping to facilitate your recovery. You will also need to stop taking any blood-thinning medication, like aspirin, before the surgery, according to your doctor’s advice.

During the pre-surgery appointment, your doctor will make specific recommendations to help you prepare for the procedure.

What to expect after lung cancer surgery

If you have open surgery, the healing process may take longer. You may be required to stay in the hospital for up to a week if there are no complications. Patients that have VATS or RATS usually go home sooner.

Right after the surgery, you can expect:

• Pain – you may feel pain for a few months after the surgery. Your doctor will prescribe painkillers right after the operation, though the need for them will subside with time.

• Breathing difficulties – you may find it hard to breathe for a couple of weeks after the surgery, but this will go away with time. To ease this side effect, your doctor may recommend breathing exercises.

Depending on your condition before the surgery, the lung cancer surgery recovery time may vary from a few weeks to several months. During this period, you may need assistance with everyday activities, such as cooking, shopping, or driving.

The lowdown

Lung cancer surgery can be an effective treatment method for early-stage non-small cell and, in some cases, small cell cancers. It can also ease the symptoms and possibly improve the survival rate for patients with late-stage lung cancer.

During lung cancer surgery, it's possible to remove all cancer from the patient's body if caught in the early stages. In many cases, this operation provides the best shot at curing the disease.