Lung Cancer Surgery


There are several different types of surgery that may be done for lung cancer that vary in the amount of lung tissue removed.
The type of surgery needed for lung cancer depends on:

  • The size of the cancer

  • The position of the cancer in the lung

  • The type of lung cancer (small cell or non small cell lung cancer)

  • Whether it has spread

Non small cell lung cancer :
Surgery is mostly used to treat non small cell lung cancer. But surgery might not be suitable if the cancer is very near to any of the following structures:

  • The heart

  • The windpipe

  • The food pipe (oesophagus)

  • Major blood vessels

Small cell lung cancer :
Surgery is not normally used to treat small cell lung cancer, unless it is at a very early stage. Small cell lung cancer usually spreads beyond the lung when it is diagnosed and so it is not possible to remove all of it with surgery. It is more common to have chemotherapy and radiotherapy rather than surgery for small cell lung cancer.


Types of Lung Cancer Surgery

There are four primary types of lung cancer surgery, though variations on these procedures may be recommended based on individual situation.

Removing one lobe (lobectomy) :
Lobectomy means removing one lobe of the lung. The surgeon will recommend this type of operation if the cancer is just in one part of one lung. It is the most common type of operation for lung cancer.

Removing two lobes (bilobectomy) :
This means removing two lobes of the lung.

Removing the whole lung (pneumonectomy) :
The operation to remove the whole lung is called a pneumonectomy. This operation is recommended if the cancer is in the central area of the lung and involves either the two lobes in the left lung or the three lobes in the right lung.

Removing a section of lung :
Some operations remove particular areas of the lung.

Wedge Resection :
A wedge resection removes the portion of the lung that includes the tumor, and some surrounding tissue. It is most commonly done when a tumor is caught very early, or if surgery that is more extensive would interfere too much with breathing.

Segmental Resection (Segmentectomy) :
In a segmental resection, a larger piece of tissue is removed than with a wedge resection, but less than an entire lobe. In this procedure, a surgeon may remove one or more segments of a lobe of a lung.

Sleeve Resection :
A sleeve resection involves removal of part of a bronchus along with lung tissue, and is analogous to removing part of a sleeve of a shirt (and part of the body of the shirt) and then joining the portions of the sleeve above and below the removed section back together. It is often done as an alternative to pneumonectomy for central tumors that are growing into a bronchi (to avoid removal of an entire lung). This operation is not as common as other types of lung cancer surgery.

Removing lymph nodes :
During the operation the surgeon examines the lung and surrounding area. They take out some of the nearby lymph nodes in case they contain cancer cells that have spread from the main cancer. This is called lymphadenectomy.


Methods of surgery

The methods by which lung cancer surgery is performed can also vary, from open surgery to robotic surgery.

Open surgery :
The surgeon makes a cut that runs around the side of the chest. This is called a thoracotomy. Sometimes the cut may only be a few centimetres long. But it can also be longer and run from under the nipple around to the back under the shoulder blade.

Keyhole surgery :
Keyhole surgery can remove very small, early, non small cell lung cancers. The medical name for this operation is Video Assisted Thoracoscopic Surgery (VATS). They use a long, bendy tube called a laparoscope. In this procedure, several small incisions are made in the chest through which instruments are inserted. These instruments are used to excise lung tissue, which is then removed through the small incisions.


Alternatives to Lung Cancer Surgery

Stereotactic Body Radiotherapy (SBRT) :
It is a radiation procedure in which high doses of radiation are delivered to a small area of tissue, and may be used as an alternative to surgery for some early stage lung cancers.

Proton Beam Therapy :
It is similar to conventional radiation therapy, with the exception that protons are used instead of photons or X-rays to create tissue damage. This treatment can deliver high doses of radiation to precise areas of tissue, and may be considered as a curative approach for some very early stage lung cancers.

Radiofrequency Ablation :
Radiofrequency ablation use techniques such as microwaves to destroy cancerous tissue in the lungs.