Medically Reviewed by Dr. K on 1 April 2021
Table of contents
Lung Cancer Surgery
For patients with early-stage non-small-cell lung cancer or NSCLC, surgery is the preferred treatment option. Unfortunately, the majority of patients with progressive or metastatic cancer are not surgical candidates.
People with NSCLC that has not spread will normally survive surgery if their lungs are in good enough condition.
Surgery is seldom used in the management of small-cell lung cancer (SCLC). Since SCLC spreads so quickly and widely across the body, surgical removal is typically difficult. Chemotherapy, nuclear, or immunotherapy are most likely to be used by your doctor.
What Are the Types of Surgery for NSCLC?
In certain cases, a doctor will remove some or all of your lung which has cancer. The scale of the cancerous tumor’s removal is determined by its size, position, and how far it has spread. One or more of the following choices can be discussed with you by your surgeon:
Lobectomy. The lobes of your lungs are made up of various sections. There are three lobes in the right lung and two in your left lung. A lobectomy is the surgical removal of a cancerous tumour from a lobe. When it comes to NSCLC, doctors like to perform this type of operation whenever possible.
Segmentectomy or wedge resection. There are two techniques that remove a section of a lobe. If your surgeon believes that removing an entire lobe would prevent your lung from functioning properly, they might prefer one of these options.
Pneumonectomy. The cancerous lung is removed by the doctor. If the tumour is near the middle of your chest or if a lobectomy isn’t enough to remove it, you will require this procedure.
Sleeve resection. This typically means the doctor removing a cancerous lobe as well as a section of a wide airway known as a bronchus that links your windpipe to your lung. There are two of these airways in your body, one for each lung. The surgeon then connects the major section of the bronchus to the part of the lobe that is already healthy. If they believe it will help you breathe better, they may perform this procedure instead of a pneumonectomy.
Lung cancer surgery, like all surgeries, has complications. Inquire about the potential side effects and risks of any operation the doctor recommends for you.
What Happens During Surgery?
Your medical team at the hospital prescribes general anaesthesia to you with an IV prior to the surgery. It induces “sleep" and prevents you from experiencing discomfort.
Once you’re asleep, the surgeon will access your lung using one of two methods:
Thoracotomy. They make a wide cut (or “incision") in the side of your chest or back between your ribs.
Video-assisted thoracic surgery (VATS). One to four minor cuts are made in your chest. Then they insert a tiny camera into the lung to view images of it as they work. Some doctors use a device to perform VATS, which allows them to make more precise movements using their surgical instruments.
VATS is a less aggressive form of surgery that is used to treat early-stage NSCLC where it is possible. Traditional surgery normally takes longer to recover from than this form of minimally invasive surgery.
What Happens After Surgery?
Your medical team will transport you to a recovery area before returning you to your hospital room. They’ll be with you the whole time.
You may feel groggy when you first wake up. Your medical team will administer pain relievers for you. Tubes in your chest that the doctor inserts during the surgery to drain fluid and blood are normal, and they’re normally removed within a few days. If you need to return home with a tube in place, the doctor or nurse will explain how to care for it.
A respiratory therapist can assist you with treatments to help your lungs function better while you’re in the hospital. They can use medications, a spirometer (a device that measures how well you breathe), or both. You should inquire with the nurses as to whether you may be able to get up. You may even ask them how to look after your recovering incision and how to change your surgery bandages.
Your doctor or nurse will send you a list of guidelines for how to recover at home before you leave the hospital.
What if Surgery Isn’t Right for You?
If surgery is ruled out due to your overall health, age, or another cause, your doctor can discuss one of these procedures for NSCLC.
Photodynamic therapy (PTD). Early-stage lung cancers that haven’t advanced into the exterior layers of the lung airways can be treated with this procedure, which combines medications and laser light. It may also be used to treat cancers that obstruct airways, making it easier to breathe.
Your doctor will then inject you with a medication named porfimer sodium. Then you go home to wait for the medication to build up in your cancer cells for a few days. Your doctor will either give you medications to numb your throat and relax you on the day of the surgery, or general anaesthesia to help you to sleep. They insert a bronchoscope, a small, translucent tube with a tiny camera on it, into the nose or mouth. They direct this down your throat to the lung tumour. The medication in the cancer cells is then activated and killed by laser light on the device’s end. Your doctor will use a bronchoscope to clear the dead cells after a few days.
For a couple of days afterward, the airway can be swollen, leaving you to feel out of breath or forcing you to cough up blood or mucus. Your doctor’s light-sensitive medication will even trigger skin reactions, such as severe sunburn. For many weeks after the injection, you must prevent intense indoor or outdoor sun. Wear sunscreen, sunglasses, a cap, and sun-protective apparel whenever you head outdoors.
It’s likely that you’ll need to get PTD more than once for the medication to be successful.
Laser therapy. This treatment will burn away small tumours in your airway linings or bigger tumours that are covering your airways. Before the surgery, the doctor will typically administer general anaesthesia. They pass a bronchoscope down your throat and put it next to your lung tumour until you’re unconscious. The tumour is then destroyed using a laser on the device’s end. It’s possible that you’ll require laser treatment more than once to get the maximum outcomes.
Radiofrequency ablation. Radio waves are used to heat cancerous tumours in this procedure. If the tumours come near to the edge of your lung, it might help.
Your doctor will send you a dose of numbing medicine called local anaesthesia before the surgery. You may also request sedatives to help you relax. The doctor then sticks a small, needle-like tube into the portion of the body that is numb. To see through the body and direct the tip of the device through your tumour, they use a CT scan imaging tool. When implanted, the system passes an electric current into the tumour, which heats it up and destroys cancer cells.
For a couple of days afterward, you might have discomfort where the needle was inserted.
Cryosurgery. Cryosurgery is a procedure that is often used to treat NSCLC. It’s also known as cryotherapy or cryoablation. The tumour is frozen and dissolved during cryosurgery. This technique is usually used by people who are unable to handle conventional surgery.
Your medical team will either offer you medications to numb your throat and relax you or general anaesthesia to put you to sleep until the surgery. A thin tube called a cryoprobe is then placed into your nose or mouth and directed down to your lung by your doctor. They achieve this by using diagnostic scans such as ultrasound, CT, or MRI to see through the body. When the cryoprobe comes into contact with the tumour, it releases an intensely cold gas or fluid that kills cancer cells. You will need to spend the night in the hospital afterward.
Cryosurgery is now being tested to see how it will help in the long run. Be sure the healthcare insurance covers it if you and your doctor believe that’s best for you.
How Do You Prepare for Surgery or Another Procedure?
These general guidelines will assist you in preparing for your surgery and ensuring a faster recovery. Your doctor will provide you with detailed guidance.
Several weeks previous to the procedure:
- If you smoke, talk to the doctor about quitting.
- Complete any tests that the doctor suggests.
- Find out how much you’ll have to spend out of pocket if you have health insurance.
- Make arrangements for transportation to and from the hospital or doctors office.
- Get a loved one or friend ready to assist you with errands and tasks.
- Request time off if you work. (Your doctor will be able to tell you how many days or weeks you’ll require.)
Days leading up to the procedure:
- In the 24 hours leading up to the appointment, consult the doctor or nurse on what to eat and drink.
- Ask about the medications you’ll require.
On the day of the surgery, make the following preparations:
- Wear loose, comfortable clothing.
- Jewelry, other valuables, and contact lenses can be left at home.
- Follow all other guidance provided to you by your doctor.
What Should You Ask Your Doctor?
Ask questions regarding your rehabilitation before your surgery, such as:
- What things can I do or avoid when I’m recovering at home?
- What are the potential side effects I should be mindful of, and how can I deal with them?
- How long do you think I’ll be out of breath?
- What kind of follow-up appointments would I require?
- Is it probable that physical rehabilitation would assist my recovery? If that’s the case, when should I begin?
What’s Recovery Like?
It is based on the treatment you received and your general wellbeing.
Lung cancer treatment is a big procedure. Following the operation, several patients experience pain, weakness, fatigue, and shortness of breath. Many individuals experience trouble getting about, coughing, and breathing deeply. A recovery period of several weeks or even months is likely. At any moment, you should ask the doctor for treatments to alleviate your discomfort or side effects.
Radiofrequency ablation, cryosurgery, laser therapy, and photodynamic therapy are some of the key treatments that provide quicker and easier recovery times than surgery.
Contact the doctor if you experience any of the following symptoms:
- Discomfort while moving, coughing, or breathing deeply
- Emotional distress
- Any other concerning symptoms or drug side effects
Tell your loved ones if they can support you when you’re getting stronger, and ask your doctor any concerns you have.
Referenced on 1.4.2021
- eMedicineHealth: “Lung Cancer Surgery."
- Journal of Thoracic Disease: “Cryosurgery for lung cancer.”
- University of Maryland Medical Center: “Non-small cell lung cancer."
- UpToDate: “Management of stage I and stage II non-small cell lung cancer," “Image-guided ablation of lung tumors,” “Overview of the initial treatment and prognosis of lung cancer.”
- American Cancer Society: “Surgery for Non-Small Cell Lung Cancer,” “Palliative Procedures for Non-Small Cell Lung Cancer,” “Radiofrequency Ablation (RFA) for Non-Small Cell Lung Cancer.”
- American Lung Association: “Lung Cancer Surgery,” “Surgery Before, During, and After.”
- National Cancer Institute: “Bronchus.”
- NYU Langone Health: “Ablation Therapy for Non-Small Cell Lung Cancer.”
- National Cancer Institute: “Cryosurgery in Cancer Treatment.”