Surgery for Lung Cancer

Surgery is one of the best options if your cancer is confined to your lung.

Recent advancements in how the surgery is performed, coupled with the skill and experience of the thoracic surgeon who brings his expertise to the Halvorson Cancer Center, make it one of the best treatments, with one of the best outcomes, for early-stage lung cancer. 

Are you a candidate for lung cancer surgery?

It all depends on the specifics of your lung cancer, where it is located, and what stage it is.

Lung cancer starts in the periphery, or outer wall, of the lung, and then it tends to spread to the middle. 

Your cancer can be removed by surgery if:

  • the cancer is staying in the same place where it started
  • just some of the regional lymph nodes are affected
  • it's a Stage I tumor, or a lower-level Stage II tumor

Once lung cancer has reached the center of the chest, it's typically inoperable. Unfortunately, that's situation for 70%-80% of lung cancer patients. For them, surgery is off the table because lung cancer is so difficult to detect in its earliest, most treatable stages.

What are the types of lung cancer surgery?  

There are three main types of lung cancer surgery: 

Lobectomy: This is the standard operation for early-stage lung cancer. 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 cancer is removed. Think of it as cutting off a diseased branch of a tree, before it spreads to the center of the tree. This is a minimally invasive procedure.

Segmentectomy: In this surgery, also known as a wedge resection, only part of a lobe is removed with your tumor. Your surgeon might take this approach, for example, if you don't have enough lung function to withstand removing the whole lobe. This is a minimally invasive procedure.

Your surgeon may also opt for a segmentectomy if imaging shows something suspicious but a definitive biopsy hasn't been done. In that case, they'll take the tumor out, biopsy it to make sure it is cancer, and the go ahead with the lobectomy.

Thoracotomy: This is surgery that opens your chest. During this procedure, your surgeon makes a large incision in the chest wall between your ribs, to remove part or all of your lung. A thoracotomy may be necessary if your surgeon determines it is impossible or unsafe to perform your surgery with minimally-invasive techniques. 

What happens during my lung cancer surgery?

At EvergreenHealth's Halvorson Cancer Center, 90% to 95% of our lung cancer surgeries are minimally invasive, done by either performing a lobectomy or a segmentectomy.

The procedures involve two one-to-two inch incisions, under your ribs, to remove the lobe of your lung where your cancer is. Depending on your tumor's location, a third small incision may need to be made in your back. 

You will be under general anesthesia. A breathing tube will be inserted, along with a small IV in your wrist to monitor your blood pressure. You will also have a drainage tube placed during surgery to catch any air that the rest of your lung might leak; that tube will remain in place for one to two days.

You'll likely be in the hospital for two or three days after surgery, then discharged to rest and recover at home. You should be able to resume most of your normal activities in about six to eight weeks.

If you have a thoracotomy, where the surgeon opens your chest, you can expect to remain in the hospital for up to five days before being discharged to rest and recover at home. It may be 12 weeks before you are able to resume your normal lifestyle.

What are the possible side effects of surgery?

The biggest risks, as with any surgery, are bleeding and infection:

  • the risk of major bleeding is less than 1%
  • the risk of infection at the incision sites is 2% to 3%

Chronic pain may also develop at one or more of your incision sites, because they are right underneath your ribs where nerves are sensitive.

About 20% of people will go into a heart rhythm called atrial fibrillation after surgery. This can be treated with medication, though it may mean a few more days in the hospital.

After surgery, you may feel fatigued for a week or two, but after a few weeks, most people say they're pretty much back to normal.

Will I need additional treatment?

That depends. During surgery, some of your chest lymph nodes will be removed and tested to see if your cancer has spread. If it has, your medical team will likely recommend chemotherapy or radiation after surgery to kill any remaining cancer cells. 

How soon you begin chemotherapy or radiation depends on your team's recommendations, but it usually doesn't matter what type of surgery you have. Though a thoractomy may mean a longer recovery, it likely will not delay any post-op treatment.

Both radiation and chemotherapy can also be used before surgery, to help shrink the size of your tumor.

And radiation can be used alone to kill your early-stage tumor, if surgery is not an option for you. That might be the case if:

  • you have medical issues that mean you're not a good candidate for surgery
  • you have heart problems that could be worsened by surgery
  • the surgeon would need to remove too much lung and cripple your respiratory system

You can also expect to receive follow-up CT scans every six months for two years, then a yearly CT scan after that.

Learn more about your other treatment options for lung cancer:

Medical Oncology
Radiation Oncology
Gene Therapy
Clinical Trials