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Lung Cancer Surgery

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Heart in body

The main function of the lungs is to take in oxygen from the air you breathe and to disperse it throughout the body through the bloodstream. Then as carbon dioxide flows back from the body’s cells, the lungs release this waste gas out of the body.

Every cell in the body needs oxygen to survive, making the lungs extremely essential to the body's overall function. If cancer develops in the lungs, the effects can therefore be very serious. In fact, lung cancer is the leading cause of cancer-related deaths in the United States, claiming more lives than ovarian, breast, prostate, and colon cancers combined.

There are two main types of lung cancer:

These types of cancers are grouped together because their prognosis and treatment are similar. Some examples include adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

These types of cancers spread faster but respond well to chemotherapy and radiation.

Lung Cancer Causes

The most common cause of lung cancer is smoking. This can result from the patient smoking or being exposed to second-hand smoke. Smoking damages the cells in the lining of the lungs and causes tissue to change almost immediately upon inhalation. After repeated exposure to smoke, the cells in the lungs begin to act abnormally and cancer may develop.

In addition to smoking, other risk factors for lung cancer include:

  • Repeated exposure to radon gas, asbestos, air pollution or other carcinogens
  • Chronic lung disease
  • Family history of lung cancer

Although there is no guaranteed method for preventing lung cancer, risk may be reduced by:

  • Never smoking
  • Quitting if you smoke
  • Staying away from second-hand smoke
  • Avoiding carcinogens
  • Testing your home for radon
  • Eating a healthy diet and exercising regularly

Lung Cancer Symptoms

In its early stages, lung cancer often doesn’t cause noticeable symptoms.

Symptoms typically aren’t apparent until the condition advances and may include:

  • A cough that doesn’t go away or gets worse
  • Shortness of breath
  • Hoarseness
  • Chest pain
  • Coughing up blood
  • Frequent lung infections

Once cancer has spread, other symptoms may appear including:

  • Unexplained weight loss
  • Headaches
  • Bone pain

Surgical Treatment Options

Surgery is most often considered for early-stage non-small cell lung cancers (NSCLC). When the cancer is localized and has not spread, this treatment option may provide the best chance to cure the disease. But surgery is not always an option for treating lung cancer. Each case must be carefully considered based on a number of options.

If it is determined that a patient with lung cancer would benefit from lung cancer surgery, there are a variety of procedures that may be performed. The type of surgery will depend on the size, location, and stage of the cancer, as well as a patient’s overall health.

Options for lung cancer surgery include:

This procedure includes the removal of the cancerous tumor as well as a small wedge-shaped section of lung tissue in the surrounding area.

This involves the removal of a larger section of lung tissue than a wedge resection but not the whole lobe, preserving noncancerous tissue. It may also be called a segmental resection.

This is the most common form of lung cancer surgery. During surgery, the lobe of the lung that has cancerous cells is removed (the lungs are made up of 5 lobes). If cancer is in more than just a single lobe, one of these types of lobectomies may be performed:
Biblobectomy

This procedure involves the removal of two lobes of the lung but can only be done with two lobes that are directly adjacent to each other.

Sleeve Lobectomy

This may be performed when the tumor is located on one lobe and has also infected the main bronchus of the lung. The cancerous lobe and a portion of the bronchus are removed. The remaining bronchus is reconnected with the unaffected portion of the bronchus on the other lung.

Pneumonectomy

This procedure is done if the cancer cannot be removed using other methods or it is centrally located. It involves the removal of an entire lung that has been affected by cancer.

Lymphadenectomy

If cancer has spread to the lymph nodes, the surgeon will also remove any affected lymph nodes. Removing the nodes helps reduce the risk of the cancer returning in the future or spreading. The doctor will often suggest that patients undergo chemotherapy as well.

All of the above surgeries require access to the lungs. This may be accomplished using one of the following approaches:

This open access procedure involves the surgeon making a large incision along the side and back of the chest along the ribs. An instrument is used to spread the area open, providing direct access to the lungs.

Also referred to as video-assisted thoracoscopic surgery (VATS), this is a minimal access procedure involving one to four small incisions. A camera is inserted to give the surgeon visual access to the lungs and small instruments are inserted to perform the surgery. The procedure may involve the use of a surgical robot (when done using a robotic system, this may be referred to as RATS – robotically-assisted thoracic surgery). Either way, this type of procedure typically results in shorter hospital stays and fewer complications but it is only usually recommended for early-stage lung cancer.

Risks of Lung Cancer Surgery

All surgery involves some risk. The most common risks associated with lung cancer surgery include:

  • Bleeding
  • Infection
  • Collapse of the lung
  • Pneumonia
  • Damage to nearby structures
  • Blood clots
  • Reaction to anesthesia

What to Expect After Surgery

Following lung cancer surgery, patients spend some time in the hospital. The length of time depends upon the type of procedure performed, as well as the patient’s overall health status, age, and need for post-surgical care (5 to 7 days is typical). After surgery, most patients initially stay in the intensive care unit (ICU) where their vital signs are closely monitored. They are then moved to a regular patient room when it is deemed safe to do so. When able, patients will be encouraged to sit up and walk around in order to regain strength and reduce the risk of blood clots. About 3 to 4 days after surgery, the chest tube placed to drain fluid during and after surgery will be removed.

Once home, patients may gradually return to their daily activities. The timeframe for this will be based on the type of procedure performed, the patient’s general health and energy levels, and specific doctor recommendations. If the procedure is done using a thoracotomy, activity may be limited for at least a month or two.

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