Surgery to remove the cancer (often along with other treatments) may be an option for early stage non-small cell lung cancers. If surgery can be done, it provides the best chance to cure NSCLC. Lung cancer surgery is a complex operation that can have serious consequences, so it should be done by a surgeon who has a lot of experience operating on lung cancers.
If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done beforehand to determine if you will have enough healthy lung tissue left after surgery. Other tests will check the function of your heart and other organs to be sure you're healthy enough for surgery.
Types of lung surgery
Several different operations can be used to treat (and possibly cure) non-small cell lung cancer. These operations require general anesthesia (where you are in a deep sleep) and a surgical incision between the ribs in the side of the chest (called a thoracotomy).
- Pneumonectomy: an entire lung is removed in this surgery.
- Lobectomy: a section (lobe) of the lung is removed in this surgery.
- Segmentectomy or wedge resection: part of a lobe is removed in this surgery.
Another type of operation, known as a sleeve resection, may be used to treat some cancers in large airways in the lungs. If you think of the large airway with a tumor as similar to the sleeve of a shirt with a stain an inch or 2 above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and sewing the cuff back onto the shortened sleeve. A surgeon may be able to do this operation instead of a pneumonectomy to preserve more lung function.
With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.
The type of operation your doctor recommends depends on the size and location of the tumor and on how well your lungs are functioning. In some cases, doctors may prefer to do a more extensive operation (for example, a lobectomy instead of a segmentectomy) if a person's lungs are healthy enough, as it may provide a better chance to cure the cancer.
When you wake up from surgery, you will have a tube (or tubes) coming out of your chest and attached to a special canister to allow excess fluid and air to drain out. The tube(s) will be removed once the fluid drainage and air leak subside. Generally, you will need to spend 5 to 7 days in the hospital after the surgery.
Video-assisted thoracic surgery: Some doctors now treat some early stage lung cancers near the outside of the lung with a procedure called video-assisted thoracic surgery (VATS), which is less invasive than a thoracotomy.
During this operation, a thin rigid tube with a tiny video camera on the end is placed through a small hole in the side of the chest to help the surgeon see the chest cavity on a TV monitor. One or two other small holes are created in the skin, and long instruments passed through these holes are used to do the same operation that would be done using an open approach (thoracotomy). One of the incisions is enlarged if a lobectomy or pneumonectomy is done to allow the specimen to be removed. Because usually only small incisions are needed, there is less pain after the surgery and a shorter hospital stay – usually 4 to 5 days.
Most experts recommend that only early stage tumors smaller than 3 to 4 centimeters (about 1½ inches) near the outside of the lung be treated this way. The cure rate after this surgery seems to be the same as with older techniques. But it is important that the surgeon doing this procedure is experienced since it requires a great deal of technical skill.
Possible risks and side effects of lung surgery
Possible complications during and soon after surgery depend on the extent of the surgery and a person's health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia. While it is rare, in some cases people may not survive the surgery, which is why it is very important that surgeons select patients carefully.
Surgery for lung cancer is a major operation, and recovering from the operation typically takes weeks to months. Because the surgeon must spread ribs to get to the lung when doing a thoracotomy, the incision will hurt for some time after surgery. Your activity will be limited for at least a month or two.
If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after some time if a lobe or even an entire lung has been removed. If you also have non-cancerous lung diseases such as emphysema or chronic bronchitis (which are common among heavy smokers), you may become short of breath with activities after surgery.
Surgery for lung cancers with limited spread to other organs
If the lung cancer has spread to the brain or adrenal gland and there is only one tumor, you may benefit from having the metastasis removed. This surgery should be considered only if the tumor in the lung can also be completely removed. Even then, not all lung cancer experts agree with this approach, especially if the tumor is in the adrenal gland.
For tumors in the brain, this is done by surgery through a hole in the skull (craniotomy). It should only be done if the tumor can be removed without damaging vital areas of the brain that control movement, sensation, and speech.
Surgery to relieve symptoms of NSCLC
If you can't have major surgery because of reduced lung function or other serious medical problems, or if the cancer is widespread, other types of surgery may still be used to relieve some symptoms.
For example, sometimes fluid can build up in the chest cavity outside of the lungs. It can press on the lungs and cause trouble breathing. To remove the fluid and keep it from coming back, doctors sometimes perform a procedure called pleurodesis. A small cut is made in the skin of the chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or a chemotherapy drug is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleura) to stick together, sealing the space and limiting further fluid buildup. The tube is generally left in for a couple of days to drain any new fluid that might accumulate.
Other, non-surgical techniques can also be used to relieve symptoms. For example, tumors can sometimes grow into airways, blocking them and causing problems such as pneumonia or shortness of breath. Treatments such as laser therapy or photodynamic therapy can be used to relieve the blockage in the airway. In some cases, a bronchoscope may be used to place a stent (a stiff tube) made of metal or silicone in the airway after treatment to help keep it open. These procedures are described in more detail in the section "Other local treatments."
For more general information about surgery, please see our separate document, Surgery.
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