Surgery is usually suitable for people with early stage lung cancer, who are fit enough for an operation. However, advances in keyhole surgery for lung cancer, now means more people are able to have surgery if their lung cancer is caught early enough.
Successful surgery for lung cancer, with the chance of cure, may only be possible after the surgeon has considered the following points:
- You and your lungs must be fit enough generally to cope with surgery
- The tumour must not have spread to other parts of your body.
It is more common for non-small cell lung cancers to be surgically removed as they are generally slower growing. However, small cell lung cancer can occasionally be removed if the disease is at a very early stage of development. An experienced surgeon will always try to operate when at all possible.
Can I have surgery?
A team of health professionals (including a thoracic surgeon) will work together on your care, directly or indirectly. This is the multi-disciplinary team, or MDT.
This team will review your CT scans, PET scans and lung function tests, to decide on the best treatment. They will also discuss the need for further tests to accurately diagnose your tumour.
You will then see the appropriate specialist to treat your lung tumour, such as a thoracic surgeon or oncologist. An oncologist is a cancer doctor who specialises in chemotherapy and radiotherapy treatments.
Who will carry out my operation?
Lung operations are done by thoracic or cardiothoracic surgeons. Your surgeon will have regular experience of lung cancer surgery, and should work as part of the multi-disciplinary team or MDT. Your surgery will be carried out at your nearest thoracic (lung) surgery department or unit.
Being told I was going to have surgery was the ‘best’ possible news for me personally, as I felt there was going to be a ‘positive outcome’.Pat, underwent lung cancer surgery in 2012
There are three primary methods for lung cancer surgery:
Thoracotomy / Open surgery
An incision is made around the side of your body, below your shoulder blade and between your ribs. The ribs are spread to get access to the lungs.
Video Assisted Thoracoscopic Surgery (VATS) / Keyhole Surgery
Your surgeon uses a video camera and one to three small cuts (1-5cm) to perform the operation. Incisions are generally made under the arm and/or just below the shoulder blade. The ribs are not spread.
This is a cut made vertically down the chest over the breastbone, which allows the surgeon to see both the left and right side of the chest. It is occasionally used for some lung operations.
During surgery, a part or all of a lung may need to be removed, particularly if it contains a tumour. The amount of lung that is removed will depend on location, size of your tumour, biopsy results, spread of your cancer; and sometimes on your levels of fitness before surgery.
After your operation, you will be encouraged to exercise regularly in order to make the remaining lung tissue recover and work harder for you.
- Segmentectomy/Wedge resection:– Each lobe of the lung is made up of several segments. If your fitness will not allow more extensive surgery, or the cancer is small, your surgeon may be able to remove just a segment, or a small piece of lung tissue surrounding the cancer, rather than the whole lobe.
- Lobectomy: This is the most common operation for lung cancer. It is chosen if your cancer is contained in a single lobe, and you are reasonably fit.There are 2 lobes on the left and 3 on the right. It involves the removal of a lobe of the lung. The remaining lung will expand to fill the space left by the tissue that has been removed.
- Bi-lobectomy: This is the removal of two lobes of the lung on the right side.
- Sleeve lobectomy: This is removing part of the main airway or lung artery, with the lobe being removed. The two ends are sewn together. This procedure can avoid removing the whole lung for some patients.
- Pneumonectomy: This means removing a whole lung and is chosen when the tumour extends beyond just one lobe. You may feel breathlessness after surgery this a little more common after this procedure. Along with removing the tumour using one of these techniques, the surgeon will remove lymph glands or nodes from your chest. This helps decide if further treatment, such as chemotherapy, is needed after surgery
Surgery should be performed as soon as possible after completing the preoperative assessment.
After the operation, you may be offered chemotherapy if the surgery has completely removed the cancer.
This can destroy any cancer cells that might still be in the body. There are advantages and disadvantages of undergoing chemotherapy which doctors will explain fully to patients.
If the surgery has not completely removed the cancer, you may be offered radiotherapy or chemotherapy treatment. Doctors will fully discuss all options with you.
There is a chance of having some problems after the surgery. This can include a chest infection (pneumonia), wound infection, and an irregular heart rhythm, which may require further treatment or even additional support for your breathing.
Other complications of surgery can include excessive bleeding, blood clot in your leg (deep vein thrombosis or DVT) or blood clot in your lung (pulmonary emboli).
You can help prevent some problems after surgery by getting in the best possible condition for surgery. If you smoke, it’s very important that you stop smoking as soon as possible. This will increase both your body’s ability to heal and your ability to recover from the anaesthetic. Stopping smoking will reduce your risk of complications after surgery.
Surgery is uncomfortable and it is not possible to take all the discomfort away. However this should be controlled. Please let the nurse or doctor know if you have any pain.
You must have enough pain relief to cough and breathe comfortably. A combination of regional techniques like epidural or paravertebral catheters, intravenous and tablet painkillers is common.
If you have an epidural it will normally be in for a few days after your operation. This is a fine plastic tube that leaks local anaesthetic and sometimes strong painkillers like morphine into the area near the spinal cord, creating numbness in the chest wall.
If you are able you can move around the bed area and sit in a chair. The nurse will ask you about your pain relief regularly.
I was in pain at times but the hospital did everything they could to manage it. I would wait to see if the pain would subside but as soon as I requested pain medication it was available immediately.”Brian, underwent lung cancer surgery in 2014
A paravertebral catheter may be used instead of an epidural for pain relief. A small tube is placed in the paravertebral space, in the vicinity of the thoracic spinal nerves.
Patient Controlled Analgesia (PCA) is often used in the initial period after surgery. It uses a pump that allows you take control of your own pain relief. You can give yourself a small dose of morphine (commonly used to treat cancer pain), by pressing the button on the handset. It is injected through a needle in the back of your hand.
You cannot overdose with a PCA no matter how often you press the button. It is a good idea to use the PCA before doing anything physical, like moving around or doing your physiotherapy exercises. If you still have pain despite using the PCA regularly then other methods of pain relief can be used.
Most people have side-effects of one sort or another. Side effects vary from person to person and depending on the type of lung cancer surgery you have had.
Many people find their breathlessness improves in the first 4-8 weeks after their operation. Breathlessness after surgery depends on how breathless you were before surgery, and how much lung your surgeon has removed.
They had to take the whole lung out but there’s still lots I can do and do do. I can’t probably climb mountains any longer, not that I ever did it in my life before! I can’t scuba dive apparently, someone told me, well I didn’t do that before either!Liz, underwent surgery for lung cancer in 2013
You are an individual and will recover in your own time so try not to compare your recovery with anyone else’s.
Returning to work may take anything from 1-3 months and will depend on how quickly you recover from the operation. It may also depend on the type of work you do, for example, how physically demanding your job is or whether you have to stand for long periods of time. Discuss with your GP or cancer doctor about when you will be fit enough to return to work