Surgery is the first line of treatment for (and can be enough to cure patients who have) localized non-small cell lung tumors that have not spread (or metastasized) to other parts of the body. Non-small cell lung cancer is one of two primary types of lung cancer (named for how the cancer cells look under a microscope). Surgery is rarely used for the other primary type, called small cell lung cancer, which can metastasize early and extensively, becoming inoperable.
There are two general approaches to lung cancer surgery:
Open surgery: A thoracotomy involves making incisions on the back and the chest following the curves of the ribs, then dividing muscles of the chest wall and spreading the ribs with a retractor to access the lung.
Minimally invasive surgery: Thoracoscopy (also known as video-assisted thoracoscopic surgery, or VATS) involves the surgeon inserting tiny instruments and a camera through small incisions in the chest, with guidance from images on a video screen. Robotic surgery is also a minimally invasive surgery, but it uses robotic arms to perform the operation through those same small incisions in the chest.
The amount of tissue the surgeon removes depends on such factors as the type of lung cancer, as well as its size and position, and whether it has spread. The surgeon may recommend the following:
Lobectomy: This removes an entire lobe that has been affected by cancer. There are three lobes on the right lung and two on the left. Each one has the same function—to bring oxygen to the bloodstream and remove carbon dioxide. Lobectomy is the most common and preferred method for treating for non-small cell lung cancer.
Segmental resection: This removes part of a lobe.
Sleeve lobectomy: When lung cancer is found in the large airways of the lung, the surgeon cuts out the diseased area and then sews together the remaining parts. This may include removing one of more lobes to remove all disease.
Wedge resection: Removal of a part of a section of lung that includes part of one or more lobes.
Pneumonectomy: An entire lung is removed.