Surgery

Surgery is one of the main ways to treat lung cancer. The goal of surgery in treating lung cancer is to remove all of the cancerous (malignant) tissue from the lungs.¹

Surgery is not a good option for every person. Those whose disease has spread (metastatic lung cancer) or those living with certain other health conditions may not be good candidates.¹

Surgery by lung cancer stage

Surgery is most effective when the cancer is caught early. The right type of surgery depends on the stage of lung cancer. Stages include:^1,2

• Stage 1 – The tumor is small (up to 4 cm) and no lymph nodes are involved. There are no metastases, meaning the cancer has not spread.
• Stage 2 – The tumor is small (up to 7 cm), and there may be cancer in the nearby lymph nodes. There are no metastases.
• Stage 3A – The tumor is small with nearby lymph node involvement. Or the tumor is larger with no lymph node involvement. Or the tumor is larger with lymph node involvement. There are no metastases. Surgery is not always a good option for these patients. Other treatments, like chemotherapy or radiation, may be better options.
• Stage 4 – The cancer has spread to other areas of the body. This is also known as metastatic lung cancer. Surgery is less common with this stage of lung cancer. Doctors may use other treatments to control the disease.

Evaluation before surgery

Before surgery, you will have a full evaluation. This helps your doctor decide whether surgery is right for you. The evaluation may include:³

• Imaging tests – X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans are used to identify the size and location of the tumor.
• Lung function tests – Also called pulmonary function tests, these check how well your lungs are working.
• Biomarker testing – Your doctor may want to do biomarker testing. This tests the tumor for specific DNA changes or proteins that can help determine which treatment will work best.

Types of surgery for lung cancer

During surgery, surgeons remove the tumor as well as a portion of healthy tissue around the tumor to ensure all the cancerous cells are removed. The amount of tissue removed depends on the size of the tumor.¹

There are several types of lung cancer surgery, based on how much tissue is removed:^1,4-6

• Pneumonectomy – An entire lung is removed.
• Lobectomy – A portion (lobe) of the lung is removed. If 2 lobes are removed, it is referred to as a bilobectomy.
• Wedge resection – A small, wedge-shaped portion of the lung is removed.
• Segmentectomy – A larger portion than a wedge resection is cut out.
• Sleeve resection / sleeve lobectomy – Sections of the airway above and below the tumor along with the tumor itself are removed. The sections of the airway are then reconnected.
• Lymph node sampling – Some of the nearby lymph nodes are removed to determine if the cancer has spread.
• Mediastinal lymphadenectomy – The lymph nodes between the lungs are removed. (The benefits of complete mediastinal lymphadenectomy versus lymph node sampling are controversial.)

Methods of lung cancer surgery

The 3 most common methods of lung cancer surgery are:^1,7

• Thoracotomy – This is a traditional open surgery. The surgeon makes a large cut in the chest to access the lungs.
• Video-assisted thoracic surgery (VATS) – This is a less invasive method. The surgeon uses small cuts and a camera to guide the surgery. Recovery is usually faster than with a thoracotomy.
• Robotic-assisted thoracic surgery (RATS) – This is another minimally invasive option. The surgeon uses a robotic system to perform precise movement. It also involves smaller cuts and less pain after surgery.

Your surgeon will choose the method based on your overall health, the stage of the cancer, and the location of the cancer.¹

Additional lung cancer treatment options

Sometimes, surgery is combined with other treatments. These treatments may include:^8-11

• Chemotherapy – This treatment uses drugs to kill cancer cells. It can be given before or after surgery.
• Radiation therapy – This treatment uses high-energy rays to target cancer cells. It may also be used before or after surgery.
• Targeted therapy – This is a newer treatment that targets and kills specific cancer cells and stops cancer cells from growing.
• Immunotherapy – This treatment uses your own immune system to help fight the cancer.

Talk to your doctor

If you or a loved one has lung cancer, surgery may be a key part of treatment. Ask your doctor about surgical options and what to expect. The more you know, the more confident you can feel about your care.