Lung cancer surgery may be an option for some patients, depending on the type, location, and stage of their cancer, as well as their overall health. The goal of surgery is to remove the tumor along with some surrounding lung tissue and often nearby lymph nodes. Surgery is typically the best option when the cancer is localized and unlikely to have spread, such as in early-stage non-small cell lung cancers and carcinoid tumors.

How Is Lung Cancer Surgery Performed?

There are two commonly used approaches to remove portions of the lung: thoracotomy and minimally invasive surgery. The choice of method depends on the location, size, and stage of the lung tumor, as well as the surgeon's expertise.

Thoracotomy

Thoracotomy involves making an incision on the side of the chest, following the curve of the ribs. During this procedure, some of the chest wall muscles are divided, and an instrument is used to gently spread between two ribs to provide the surgeon access to the lung. Once the surgery is completed, the muscles are repaired when the incision is closed.

Minimally Invasive Surgery

Minimally invasive surgery involves making 1 to 4 small incisions to access the inside of the chest. The surgeon uses a camera to visualize the lung and special instruments to perform the surgery. This technique is known as thoracoscopy or video-assisted thoracoscopic surgery (VATS). In some cases, the surgery can be performed with the assistance of a surgical robot, further enhancing precision and control.

Types of Lung Cancer Surgery

Lumbectomy

The right lung is divided into three lobes, while the left lung has two lobes. Depending on the location and extent of the tumor, different surgical procedures may be performed:

Lobectomy is the removal (resection) of a lobe of the lung affected by lung cancer. It is the most commonly performed lung cancer surgery.

A bilobectomy involves the removal of two lobes and is only performed for tumors in the right lung where the tumor involves two adjacent lobes. This can result in:

• Right upper and middle bilobectomy

• Right middle and lower bilobectomy

A sleeve lobectomy is sometimes performed for tumors that involve one lobe and the main bronchus to that lung. The procedure includes:

• Removal of the cancerous lobe and a portion of the main bronchus.

• Rejoining the remaining end of the main bronchus with the bronchus to any unaffected lobe(s).

This procedure can avoid the need for a pneumonectomy, which is the complete removal of a lung.

Segmentectomy

Each lung lobe consists of two to five lung segments. A segmentectomy involves the removal of one to four segments of a lung lobe, allowing surgeons to remove cancerous tissue while preserving as much healthy lung tissue as possible. This procedure is an option when the tumor is small and confined to one or a few segments, helping to maintain more lung function compared to larger resections.

Wedge Resection

A wedge resection involves the removal of a small, wedge-shaped piece of lung tissue that includes the cancerous tumor and a margin of healthy tissue around it. This procedure is typically used for smaller tumors or when preserving lung function is a priority. It is a less extensive surgery compared to lobectomy or segmentectomy and is often considered for patients who may not tolerate larger resections due to other health conditions.

Pneumonectomy

Pneumonectomy is the surgical removal of an entire lung affected by cancer. This procedure is usually performed when:

• The cancer cannot be fully removed with a lobectomy.

• The tumor is centrally located and involves major structures that make partial lung removal insufficient.

This is a more extensive procedure and is typically considered when other surgical options are not feasible due to the location or extent of the tumor.

Possible Lung Cancer Surgery Side Effects

Each type of lung cancer treatment comes with potential side effects. It's important to be aware of these side effects and understand ways to cope with them before beginning treatment. Here are some potential side effects you might experience after lung cancer surgery:

Pain

Pain is common after surgery and can usually be managed with medications prescribed by your doctor.

Possible Complications

Complications from lung cancer surgery can include:

• Infection: Risk of infection at the incision site or within the chest.

• Bleeding: Risk of bleeding during or after surgery.

• Pneumonia: Risk of developing pneumonia, especially in the early postoperative period.

• Respiratory Issues: Shortness of breath or difficulty breathing due to reduced lung function.

• Blood Clots: Risk of blood clots forming in the legs (deep vein thrombosis) or lungs (pulmonary embolism).

Coping with Side Effects

• Pain Management: Follow your doctor's instructions for pain relief, including medications and other techniques.

• Infection Prevention: Keep the surgical site clean and follow your doctor's recommendations for wound care.

• Respiratory Exercises: Engage in breathing exercises and physical therapy to improve lung function and prevent pneumonia.

• Activity and Rest: Balance rest and activity as advised by your healthcare team to promote recovery and prevent complications like blood clots.

It's crucial to discuss any concerns, possible side effects, and any effects you experience with your surgeon to manage and mitigate these issues effectively.