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Surgical Procedures for Lung Cancer

June 10, 2008 - 7:30am
 
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This page discusses the use of surgery for the treatment of lung cancer. For a thorough review of surgical procedures for cancer treatment, please see the surgery treatment monograph .

Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.

Surgical Removal of the Lung or Portions of the Lung

Surgery is used to remove the cancer cells from the lungs. It is primarily used for early stage, non-small cell lung cancer. Fewer than 30% of patients are diagnosed early enough to benefit from surgery.

There are a few options for surgery:

  • A wedge resection – removal of a small part of the lung
  • Lobectomy – removal of an entire lobe of the lung
  • Pneumonectomy – removal of the entire lung
The amount of lung removed depends on several factors, including the size and location of the tumor, if lymph nodes have cancer in them, and how well the lungs are functioning.

Description of the Procedure

Most lung cancer surgery involves a thoracotomy, a surgical method for opening the chest wall in order to access the lungs. The doctor makes an incision between two ribs from front to back. Then, the chest wall is opened, which provides access to the lungs.

A newer, less-invasive procedure, using a tiny camera inserted into the chest, may be possible but only for small tumors. This video-assisted procedure should only be performed by a surgeon experienced in this new technique.

Once the surgeon has access to the lungs, he or she removes the cancerous tissue and/or tumor from the lungs. If the cancer has spread outside the lung, the surgeon will remove that tissue also. To ensure that the lungs will reinflate after surgery, one or more catheters (chest tubes) are inserted to drain air and blood from the pleural space between the lungs and chest wall. The incision is closed with stitches or staples, and bandaged to prevent infection. You will be sent to the intensive care unit for recovery.

Effectiveness

Even with surgery, which offers the best chance for a cure, lung cancer often recurs. The doctor may recommend radiation or chemotherapy post-operatively.

Possible Complications

The following complications may occur with lung surgery:

  • Bleeding in the lung cavity (hemothorax)
  • Infection
  • Reaction to anesthesia
  • Collection of air or gases in the lung cavity (pneumothorax)

Postoperative Care

After surgery, you may need certain interventions:

  • Catheters – several catheters (tubes) are inserted after surgery, and removed as your body regains function:
    • Urinary catheter to measure urine output and avoid the need to urinate in the bathroom
    • Endotracheal tube in the trachea (windpipe) to assist breathing
    • Chest tube to remove air, blood, or fluid from the pleural space
    • Nasogastric tube, which is inserted through the nose and into the stomach, to remove stomach secretions
  • Ventilator – a machine, usually connected to an endotracheal tube, that can breathe for you
  • Medications – you may be given antibiotics, pain medication, or anti-nausea drugs after surgery

In the hospital and after you leave:

  • Do coughing and deep breathing exercises as instructed by the nurse or respiratory therapist 3-4 times daily to help keep your lungs clear.
  • Get out of bed often and sit in a chair. Increase your activity as much as tolerated.
  • Stay well hydrated.
  • Avoid environments and people that expose you to germs, smoke, or chemical irritants.

Call Your Doctor If Any of the Following Occurs

  • Difficulty breathing
  • New pain in the chest
  • Stitches or staples come apart
  • Bandage becomes soaked with blood
  • Cough up mucus that is yellow, green, or bloody
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine

Sources:

American Cancer Society

American Lung Association

Conn's Current Therapy 2001 , 53rd ed. W.B. Saunders Company; 2001.

National Cancer Institute

Primary Care Medicine , 4th ed. Lippincott Williams & Wilkins; 2000.



Last reviewed February 2003 by Jondavid Pollock, MD, PhD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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