Lung Cancer: Surgery

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. 

• 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.

• 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.

• 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.

• 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. 

• 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:

• Reactions to anesthesia

• Excess bleeding

• Blood clots in the legs or lungs

• Damage to nearby organs

• Infections at the incision site or elsewhere

Along with the risks above, lung surgery can sometimes cause:

• Pneumonia

• Loss of lung function, which might lead to shortness of breath or feeling tired

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:

• You will be moved onto the operating table.

• You may need to wear special stockings on your legs. These are to help prevent blood clots.

• You will have electrocardiogram electrodes put on your chest. These are to keep track of your heart rate.

• You will also have a blood pressure cuff on your arm.

• You will be given anesthesia through an IV in your hand or arm.

• When you are asleep, the surgeon will do the surgery.

• 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.