Surgery for small cell lung cancer

Surgery is rarely used as the main treatment in small cell lung cancer. In fewer than 1 out of 20 cases, the cancer is found as only one tumor, with no spread to lymph nodes or other organs. In these cases, surgery might be helpful. If used, it is usually followed by treatment with chemo and maybe radiation.

There are different operations that can be used to treat small cell lung cancer. For each of them you will be in a deep sleep (under general anesthesia) and will have a cut (surgical incision) between the ribs in the side of the chest.

• Pneumonectomy: the 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.

As a rule, lobectomy is the preferred operation for small cell lung cancers treated with surgery. With any of these operations, lymph nodes are also removed to look for possible spread of the cancer.

You will most likely need to spend about a week in the hospital after the surgery. There will be some pain because the surgeon has to cut through the ribs to get to the lungs. Other possible problems include bleeding, infections, and pneumonia.

Video-assisted thoracic surgery (VATS): This is a new kind of surgery for some people with early stage lung cancer. A tiny camera can be put through a small hole in the chest to help the surgeon see the tumor. One or 2 other small cuts (incisions) are made in the skin, and long instruments are passed though these to remove the tumor. Since only small cuts are needed, there is a shorter hospital stay and less pain after surgery. This approach is most often used for tumors smaller than about 1½ inches near the outside of the lung. The cure rate seems to be the same as for standard surgery. The doctor who does this surgery should have experience because it takes a great deal of skill.

Possible side effects of surgery

Problems after surgery depend on how much surgery was done and a person's health beforehand. Serious problems can include a lot of bleeding, infection, 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 with care.

People whose lungs are in good shape (other than the cancer) can often return to normal activities after some time if a lobe or even an entire lung is removed. But if they also have problems like emphysema or chronic bronchitis, which are common in heavy smokers, they may have long-term shortness of breath.

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.

Surgery and other methods to relieve problems

In some cases, surgery or other treatments may be used to help with the symptoms of the cancer (rather than trying to remove all of the cancer). For instance, laser surgery can be used to open an airway blockage that may be causing pneumonia or shortness of breath. Sometimes, metal or plastic tubes called stents may be placed in the airways to help keep them open. Other methods like radiation may also be used.

Sometimes fluid collects in the chest and makes it hard to breathe. This fluid can be removed through a small tube placed in the chest. After the fluid is drained out, either talc or some type of drug is placed into the chest. This will start a reaction that will help seal the space and prevent future fluid build-up.