Surgery for Small Cell Lung Cancer

Surgery is rarely used as part of the main treatment for small cell lung cancer (SCLC), as the cancer has usually already spread by the time it is found.

In fewer than 1 out of 20 people with SCLC, the cancer is found as only a single lung tumor, with no spread to lymph nodes or other organs. Surgery may be an option for these early-stage cancers, usually followed by additional treatment (chemotherapy).

Tests before lung surgery

If your doctor thinks the lung cancer can be treated with surgery:

  • Pulmonary function tests will be done to see if you would still have enough healthy lung tissue left after surgery.
  • Tests will be done to check the function of your heart and other organs to be sure you’re healthy enough for surgery.
  • Your doctor will want to check if the cancer has already spread to the lymph nodes between the lungs. This is often done before surgery with mediastinoscopy or another technique.

To learn more about these tests, see Tests for Lung Cancer.

Types of lung surgery

Different operations can be used to treat SCLC. In 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 large surgical incision between the ribs in the side of the chest or the back (called a thoracotomy).

  • 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 in the right lung and 2 in the left). In this surgery, the entire lobe containing the tumor(s) is removed. If it can be done, this is often the preferred type of operation for SCLC.
  • Segmentectomy or wedge resection: In these operations, only the part of the lobe with the tumor is removed. This approach might be used if a person doesn’t have enough normal 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 few inches above the wrist, the sleeve resection would be like cutting across the sleeve (airway) above and below the stain (tumor) 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.

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.

Intraoperative imaging

Along with the results of imaging tests (such as CT scans) done before surgery, surgeons also rely on what they can see and feel during the operation to help determine which parts of the lung need to be removed. However, some lung tumors might not be easily seen or felt, so in some situations it’s possible that a tumor (or parts of tumor) might be missed. 

Your surgeon might use a special intraoperative imaging system during the surgery to help find tumors that aren’t easily seen or felt. For this approach, a fluorescent drug called pafolacianine (Cytalux) is injected into your blood within 24 hours before your surgery. The drug travels through your body and attaches to a specific protein found on lung cancer cells. Once in the operating room, the imaging system gives off near-infrared light that causes the drug to light up, which can help the surgeon see which areas of the lung need to be removed.

The most common side effects after getting pafolacianine are belly pain, heartburn, itching, chest pain, nausea, vomiting, and flushing. Your doctor will probably ask you to avoid any supplements that have folic acid in them for a few days before the procedure because they might affect how well this drug works.

After surgery

When you wake up from surgery, you will have a tube (or tubes) coming out of your chest and attached to a special container to allow excess fluid and air to drain out. The tube(s) will be removed once the fluid drainage and air leak slow down enough. Generally, you will spend about 5 to 7 days in the hospital after the surgery.

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, they depend to some degree on the extent of the surgery and a person’s overall health.

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, in some cases people might not survive the surgery.

Recovering from lung cancer surgery typically takes weeks to months. When the surgery is done through a thoracotomy, the surgeon must spread the ribs to get to the lung, so the area near the incision may hurt for some time after surgery. Your activity might 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 another lung disease such as emphysema or chronic bronchitis (which are common among people who have smoked for a long time), you might become short of breath with activity after surgery.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Araujo LH, Horn L, Merritt RE, Shilo K, Xu-Welliver M, Carbone DP. Ch. 69 - Cancer of the Lung: Non-small cell lung cancer and small cell lung cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Hann CL, Wu A, Rekhtman N, Rudin CM. Chapter 49: Small cell and Neuroendocrine Tumors of the Lung. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Health Professional Version. Small Cell Lung Cancer Treatment. 2019. Accessed at https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq on June 12, 2019.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer. V.1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf on June 12, 2019.

Written by

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

References

Araujo LH, Horn L, Merritt RE, Shilo K, Xu-Welliver M, Carbone DP. Ch. 69 - Cancer of the Lung: Non-small cell lung cancer and small cell lung cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Hann CL, Wu A, Rekhtman N, Rudin CM. Chapter 49: Small cell and Neuroendocrine Tumors of the Lung. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

National Cancer Institute. Physician Data Query (PDQ). Health Professional Version. Small Cell Lung Cancer Treatment. 2019. Accessed at https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq on June 12, 2019.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer. V.1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf on June 12, 2019.

Last Revised: December 23, 2022