Lung Cancer Surgery
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:
Non-Small Cell Lung Cancer (NSCLC) – 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.
Small Cell Lung Cancer (SCLC) – These types of cancers spread faster but respond well to chemotherapy
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
- Chest pain
- Coughing up blood
- Frequent lung infections
Once cancer has spread, other symptoms may appear including:
- Unexplained weight loss
- 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:
Wedge Resection – This procedure includes the removal of the cancerous tumor as
well as a small wedge-shaped section of lung tissue in the surrounding area.
Segmentactomy – 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.
Lobectomy – 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:
Thoracotamy – 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.
Thoracoscopy – 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:
- Collapse of the lung
- 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.