The goal of surgery in treating lung cancer is to remove all of the cancerous (malignant) tissue. Surgery is not a good option for every patient, particularly those whose disease has spread (metastatic lung cancer) or those whose overall health will not tolerate surgery, such as in patients with other health conditions.
Surgery by lung cancer stage
Surgery is generally used in patients with earlier stage disease, such as the below non-small cell lung cancer stages:1,2
- Stage I: The tumor is small (between ≤1 to 4 cm) and no lymph nodes are involved. There are no metastases.
- Stage II: The tumor is small (between ≤1 to 7 cm), and there may be cancer in the adjacent lymph nodes. There are no metastases.
- Stage IIIA: The tumor is small with adjacent 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 may not always be a good option in these patients.
Evaluation before surgery
Before surgery, patients with lung cancer will be evaluated with a number of tests. Imaging tests, such as computed tomography (CT) scan and positron emission tomography (PET) scan, are used to identify the size and location of the tumor.
Pulmonary function tests are also used. Pulmonary function tests assess breathing and how well the lungs are working, and are critical in evaluating whether surgery is the right option for the patient. Since the surgery will remove a portion of the lung tissue and can impact the lung’s ability to function, the pulmonary function test provides essential information.1,3
Types of surgery for lung cancer
The amount of tissue removed during surgery depends on the size of the tumor. Surgeons remove the tumor as well as a portion of healthy tissue around the tumor to ensure all the cancerous cells are removed.
- Pneumonectomy – removal of an entire lung 1,4
- Lobectomy – removal of a portion (lobe) of the lung; if two lobes are removed, it is referred to as a bilobectomy 4,5
- Wedge resection – a small, wedge-shaped portion of the lung is removed 1,4
- Segmentectomy – cuts out a larger portion than a wedge resection, but does not remove an entire lobe
- Sleeve resection/Sleeve lobectomy – removal of sections of the airway above and below the tumor along with the tumor itself; the sections of the airway are then reconnected 5
- Lymph node sampling – removal of some of the nearby lymph nodes to determine if the cancer has spread 1,5
- Mediastinal lymphadenectomy – removal of the lymph nodes between the lungs (the benefits of complete mediastinal lymphadenectomy versus lymph node sampling remains controversial) 1
Methods of surgery
The two most common methods of lung cancer surgery include:6
- Thoracotomy - classic method of removing lung tumor where the chest cavity is opened to gain access to the lungs
- Video-assisted thoracic surgery (VATS) – a minimally invasive surgery in which a thin, lighted scope with a video camera and surgical instruments are inserted into the chest through small incisions
Patients with lung cancer who have surgery may also be given additional treatment, such as radiation therapy, chemotherapy, immunotherapy, or targeted therapy.1