Lung cancer surgery can offer a cure when the disease is diagnosed in early stages; patients with more advanced lung cancer may also need other types of treatment, possibly including chemotherapy, radiation, and immunotherapy.
If your doctor suspects you might have lung cancer—or if you have a lung cancer screening because you are at high risk for the disease—you’ll have a chest X-ray or CT scan to look for nodules (abnormalities) on your lung. A lung nodule is typically small, round, and more solid than the normal lung tissue that surrounds it. Some nodules are benign (harmless inflammation), some are the result of an infection that has healed, and some are malignant.
If your lung nodule is malignant, it means you have lung cancer. Lung cancer cells have the ability to invade surrounding tissue and spread through lymph nodes. If you are diagnosed with lung cancer, surgery is one possible treatment option. Lung cancer surgery involves removal of a part of the lung, along with nearby lymph nodes.
“At Yale Medicine’s Thoracic Surgery Program, we perform a majority (over 85 percent) of lung cancer surgeries using minimally invasive techniques such as robotic surgery or video-assisted thoracoscopic surgery (VATS), resulting in shorter hospital stays, decreased pain, and faster recovery,” says Yale Medicine’s Andrew Dhanasopon, MD, a thoracic surgeon.
Who can have surgery to treat lung cancer?
Lung cancer surgery is the standard-of-care treatment for early-stage lung cancer. To determine if you have early-stage lung cancer, your physician may order diagnostic imaging, a lung biopsy, or other testing. The following tests are performed on an outpatient basis:
- CT scan to assess the size and location of the nodule and lymph nodes.
- PET scan to assess the metabolic activity of the nodule and lymph nodes and determine whether any cancer cells have spread to other parts of the body. (An MRI is sometimes ordered to see whether cancer cells have spread to the brain.)
- CT-guided needle biopsy to confirm the diagnosis of lung cancer within the nodule.
- Endobronchial ultrasound (EBUS) with biopsy of lymph nodes to determine whether cancer has spread to lymph nodes. EBUS is sometimes used to biopsy the nodule at the same time.
- Mediastinoscopy with removal of lymph nodes to determine whether the cancer has spread to any lymph nodes.
- Pulmonary lung function testing (PFT): An assessment that measures how much healthy lung tissue you have, it's used to determine if you are a candidate for removal of part of the lung.
- Stress testing to determine if your heart is strong enough to tolerate lung surgery.
These tests confirm the diagnosis of lung cancer, identify the “clinical” or preliminary stage, and determine whether or not you are a candidate for surgery.
What are the different types of lung cancer surgery?
Your lungs are a pair of spongy, air-filled organs located on either side of the chest. Each lung is divided into lobes. Your right lung contains three lobes (upper, middle, lower), while your left lung contains two lobes (upper and lower). Each lobe has an independent blood supply and its own set of airway branches. Each lobe is further subdivided into segments, also with its independent blood supply and airway branches.
The operation for an early-stage lung cancer is removal of the lobe of the lung in which the nodule resides (called a lobectomy). Other types of lung surgery may be recommended, depending on what is most appropriate for you. Factors that will impact this decision include the location of the nodule and the results of your pulmonary function testing. The following are the types of lung surgery, with varying amounts of the lung removed:
- Wedge resection: This procedure involves removal of the nodule along with margin of healthy tissue. This is typically performed for diagnosis, especially if confirmation of cancer was not done with CT-guided biopsy or EBUS. If the wedge resection confirms cancer, removal of the remainder of the lobe is performed under the same setting.
- Segmentectomy: This type of surgery is done to remove the segment of the lobe of the lung where the nodule has been found. This is typically done if lung function testing is borderline (not very strong).
- Lobectomy: In this procedure, the most common one done for lung cancer, the lobe of the lung in which the nodule resides is removed.
- Pneumonectomy: This operation removes an entire lung. This is typically required if the cancer is large and/or close to major blood vessels or airways in the center of the chest.
What is the prognosis for lung cancer surgery?
The cure rate and recurrence rate depend on the stage at the time of diagnosis. For early stage lung cancer, surgery alone may provide a cure. If imaging and testing determine that you have locally advanced lung cancer (larger cancers that may or may not have spread to nearby lymph nodes), surgery will be only one part of the treatment plan.
Yale Medicine emphasizes teamwork and takes an evidence-based approach to care. Our surgeons work closely with our medical oncologists and radiation oncologists to determine if additional therapies, including chemotherapy, radiation therapy, and/or immunotherapy, before or after surgery, will help increase the chance at cure.
What is the recovery process for lung cancer surgery?
At Yale Medicine, our surgeons perform most lung cancer surgeries using a minimally invasive approach, through small incisions in between the ribs. This may be done by video-assisted thoracic surgery (VATS) or using the da Vinci robotic surgical system. Compared to the traditional larger incision (called a thoracotomy), minimally invasive surgery results in shorter hospital stays, improved pain, and faster recovery.
Most patients who have a lobectomy are able to go home two to four days after surgery. Once home, pain can be managed with acetaminophen and ibuprofen, along with stronger pain medication, if needed. Patients don’t usually require supplemental oxygen to walk or climb stairs; most are able to move around on their own almost immediately.
There is a follow-up visit two weeks after discharge, to assess pain and healing. At this visit, your doctor will also review the pathology report, including whether the cancer spread to the lymph nodes, and outline a plan for additional treatment, if needed. On average, patients can return to light work and most activities about four weeks after lung surgery.
What are the risks during and after lung cancer surgery?
All cancer surgeries come with some risks. Though most people do well after lung cancer surgery, the associated risks include shortness of breath or weakness with activity, a need for temporary oxygen and/or rehabilitation, increased risk for pneumonia or other infections, chronic pain, blood clots, and reactions to anesthesia.
At Yale Medicine, the goal is to minimize side effects from lung cancer surgery. “We have organized care delivery for lung cancer patients that is patient-centered and minimizes postoperative issues,” Dr. Dhanasopon says.
What is Yale Medicine’s approach to lung cancer surgery?
The surgeons who are part of Yale Medicine Thoracic Surgery Program are internationally and nationally recognized leaders, setting the standards for quality care and positive patient outcomes in the field.
“Our program coordinates the evaluation and treatment of patients with benign and malignant diseases of the lung but also of the esophagus, mediastinum, and chest wall,” says Dr. Dhanasopon.
We are at the forefront of minimally invasive techniques, advanced diagnostics and therapeutics, and clinical and translational research. Because we are the highest volume thoracic surgery program in Connecticut, we are able to provide advanced surgical care for lung cancer patients in a way that is organized, multidisciplinary, evidence-based, and patient-centered, says Dr. Dhanasopon.