Small-cell lung cancer surgery

Surgery is rarely used as the main form of treatment in small cell lung cancer (SCLC). Occasionally (fewer than 1 out of 20 cases), the cancer is found as only one localized tumor nodule, with no spread to lymph nodes or other organs. Surgery may be an option usually followed by additional treatment (chemotherapy, often with radiation therapy).

If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done first to determine whether you will have enough healthy lung tissue remaining after surgery. Other tests will check the function of your heart and other organs to be sure you're healthy enough for surgery.

Because more advanced stage lung cancers are not helped by surgery, your doctor will also want to make sure the cancer hasn't already spread to the lymph nodes between the lungs. This can be done before surgery with mediastinoscopy or with some of the other techniques described in the section "How is small cell lung cancer diagnosed?"

Types of lung surgery

Several different operations can be used to treat lung cancers. 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.
• Lobectomy: a section (lobe) of the lung is removed.
• Segmentectomy or wedge resection: part of a lobe is removed.
• Sleeve resection: a section of a large airway is removed and the lung is reattached.

In general, lobectomy is the preferred operation for small cell lung cancers treated with surgery.

With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.

You will generally need to spend about a week 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, hollow 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 though these holes are used to cut away the tumor. One of the incisions may need to be enlarged to remove the lung specimen. Usually, only small incisions are needed, so there is a little less pain after the surgery and a shorter hospital stay, usually around 4 to 5 days.

Most experts recommend that only tumors smaller than 3 to 4 centimeters (about 1 ½ inches) near the outside of the lung be removed this way. The cure rate after this surgery seems to be the same as with older techniques. But it is important that the surgeon be experienced with this procedure 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. The surgeon must spread ribs to get to the lung when doing a thoracotomy, so the incision will hurt for some time after surgery. Your activity will be limited for at least a month.

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 and other techniques to relieve symptoms of SCLC

In some cases, surgery (or other localized techniques) may be used to help treat the symptoms of the cancer (as opposed to trying to remove all of the cancer). For example, tumors can sometimes grow into airways, blocking them and causing problems such as pneumonia or shortness of breath. Treatments such as laser surgery can be used to relieve the blockage in the airway. This is done using a special type of laser on the end of a bronchoscope to destroy the tumor cells. A bronchoscope may also be used to place a metal or silicone tube (called a stent) in the airway after treatment to help keep it open. Other techniques like radiation therapy (described in the "Radiation therapy for small-cell lung cancer" section) may also be used.

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 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 pleural) 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.