Surgery for Non-Small Cell Lung Cancer
Surgery to remove the cancer (often along with other treatments) may be an option for early stage non-small cell lung cancer (NSCLC). 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 see if you would still 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.
Because surgery doesn’t help more advanced stage lung cancers, your doctor will also want to check if the cancer has already spread to the lymph nodes between the lungs. This is often done just before surgery with mediastinoscopy or with some of the other techniques described in How is non-small cell lung cancer diagnosed?
Types of lung surgery
Different operations can be used to treat (and possibly cure) NSCLC:
- Pneumonectomy: This surgery removes an entire lung. This might be needed if the tumor is close to the center of the chest.
- Lobectomy: The lungs are made up of 5 lobes (3 on the right and 2 on the left). In this surgery, the entire lobe containing the tumor(s) is removed. This is often the preferred type of operation for NSCLC if it can be done.
- Segmentectomy or wedge resection: In these surgeries, only part of a lobe is removed. This approach might be used, for example, if a person doesn’t have enough lung function to withstand removing the whole lobe.
- Sleeve resection: This operation 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 a couple of inches above the wrist, the sleeve resection would be like cutting across the sleeve above and below the stain and then 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. These operations require general anesthesia (where you are in a deep sleep) and are usually done through a surgical incision between the ribs in the side of the chest (called a thoracotomy).
The type of operation your doctor recommends depends on the size and location of the tumor and on how well your lungs are functioning. Doctors often 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 (VATS)
Increasingly, doctors now treat early-stage lung cancers in the outer parts of the lung with a procedure called video-assisted thoracic surgery (VATS), which requires smaller incisions than a thoracotomy.
During this operation, a thin, rigid tube with a tiny video camera on the end is placed through a small cut in the side of the chest to help the surgeon see inside the chest on a TV monitor. One or two other small cuts are created in the skin, and long instruments are passed through these cuts 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 only small incisions are needed, there is usually less pain after the surgery and a shorter hospital stay – typically 4 to 5 days.
Most experts recommend that only early-stage tumors near the outside of the lung be treated this way. The cure rate after this surgery seems to be the same as with surgery done with a larger incision. But it’s important that the surgeon doing this procedure is experienced, because it requires a great deal of technical skill.
Possible risks and side effects of lung surgery
Surgery for lung cancer is a major operation and can have serious side effects, which is why surgery isn’t a good idea for everyone. While all surgeries carry some risks, these depend to some degree on the extent of the surgery and the person’s health beforehand.
Possible complications during and soon after surgery can include reactions to anesthesia, excess bleeding, blood clots in the legs or lungs, wound infections, and pneumonia. While it is rare, some people may not survive the surgery.
Recovering from lung cancer surgery typically takes weeks to months. If the surgery is done through a thoracotomy (a long incision in the chest), the surgeon must spread ribs to get to the lung, so the area near the incision will hurt for some time after surgery. Your activity might be limited for at least a month or two. People who have VATS instead of thoracotomy tend to have less pain after surgery and to recover more quickly.
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 another lung disease such as emphysema or chronic bronchitis (which are common among long-time smokers), you might become short of breath with certain levels of activity after surgery.
Surgery for lung cancers with limited spread to other organs
If the lung cancer has spread to your brain or to an adrenal gland and there is only one tumor, you may benefit from having the tumor removed. This surgery should be considered only if the tumor in the lung can also be removed completely. 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 (called a craniotomy). It should only be done if the tumor can be removed without damaging vital areas of the brain.
For more general information about surgery, see A Guide to Cancer Surgery.
Last Medical Review: February 8, 2016 Last Revised: May 16, 2016
- Surgery for Non-Small Cell Lung Cancer
- Radiofrequency Ablation (RFA) for Non-Small Cell Lung Cancer
- Radiation Therapy for Non-Small Cell Lung Cancer
- Chemotherapy for Non-Small Cell Lung Cancer
- Targeted Therapy Drugs for Non-Small Cell Lung Cancer
- Immunotherapy for Non-Small Cell Lung Cancer
- Palliative Procedures for Non-Small Cell Lung Cancer
- Treatment Choices for Non-Small Cell Lung Cancer, by Stage