Surgery

Lung cancer surgery is usually the preferred treatment option for people with early stage lung cancer and involves the removal of the cancerous part of the lung.

In this section, we will cover:

• Types of surgery
• Methods of surgery
• What happens before surgery
• Preparing for your operation
• What happens during surgery?
• Recovery from surgery
• Life after surgery.

Types of surgery

There are several different types of surgery for lung cancer. The surgery you have will depend on the location and size of your tumour, the biopsy results, the stage of your cancer and, sometimes, your general health and level of fitness.

Segmentectomy / Wedge Resection

There are several segments in each lobe of your lung. A segmentectomy or wedge resection involves removing a segment, or a small piece of lung tissue that surrounds the cancer rather than the whole lobe.

Your surgeon may decide to perform a segmentectomy or wedge resection if your cancer is small, or if you are not fit enough for extensive surgery.

Lobectomy

A lobectomy is the most common type of surgery for lung cancer. It involves the removal of a single lobe of the lung. There are two lobes on the left lung and three on the right lung.

You will most likely have a lobectomy if your cancer is contained to a single lobe and you are reasonably fit.

Bi-lobectomy

If your cancer is in your right lung, your surgeon may choose to perform a bi-lobectomy. This involves the removal of two lobes.

Sleeve Lobectomy

A sleeve lobectomy involves removing part of the main airway or lung artery, as well as a single lobe, with the two ends then sewn together. This procedure can avoid removing the whole lung for some people.

Pneumonectomy

If the tumour extends beyond a single lobe, your surgeon may need to remove the whole lung. This is a pneumonectomy.

When you have any of these operations, your surgeon will also remove lymph nodes or nodes from your chest. This helps decide if you need any further treatment after surgery.

Methods for lung cancer surgery

Advances in surgery for lung cancer means there are now different methods to remove the cancer. Your surgeon will discuss with you which operation is most suitable for you, taking into account what will give you the quickest recovery and best quality of life after your treatment.

Robotic Assisted Thoracoscopic Surgery (RATS)

A RATS procedure is a minimally invasive approach to surgery. It uses three dimensional, high definition video (3DHD) and a fully articulated robotic arm that can allow surgeons to perform complex operations in tight spaces through small openings in the chest wall.

RATS is becoming more widely available, with approx. 10-15% of lung surgeries using this technique.

Video Assisted Thoracoscopic Surgery (VATS), or keyhole surgery

Your surgeon will make up to three small cuts (between 1cm and 5cm), usually under the arm and/or just below the shoulder blade. They will then use a video camera to perform the operation.

With both VATS and RATS procedures, your surgeon may decide during the operation that a thoracotomy is necessary instead. Your surgeon will fully explained this to you before your operation.

Thoracotomy

A surgeon makes an incision around the side of the body, below the shoulder blade and between your ribs. The ribs are spread to allow access to the lungs.

Median Sternotomy

A median sternotomy is occasionally used for lung operations. A vertical cut is made down the chest over the breastbone. This allows the surgeon to see both the left and right side of the chest.

What happens before surgery

Before your operation, you will likely have an appointment at a pre-surgical assessment clinic. At this appointment, you will hear about the details of your surgery and care. You will also be asked about:

• your general health
• any previous operations you have had
• if you have any allergies
• what, if any, medications you are taking.

You may also have a medical examination with your height, weight, blood pressure and other details recorded, such as blood tests and swabs.

At the appointment, you will have the opportunity to ask any questions you may have about the surgery. You will then be asked to read and sign the consent form for your operation.

Once everything has been checked out, your doctor will let you know when you operation is planed and how long you may need to stay in hospital.

Preparing for surgery

There are many things you can do to prepare both physically and mentally for your surgery.

Getting active

Improving your fitness before the operation can support your recovery.

You should do enough activity that you feel mildly short of breath. The exercise you choose will depend on your current level of fitness but it is important to try and introduce exercise into your daily routine.

This could include:

• Walking
• Cycling
• Swimming
• Gardening
• Yoga
• Playing slower sports, such as bowls.

You can also make small changes such as taking the stairs instead of the lift.

Eat well

Eating a balanced diet can help your body recover after surgery. If you are underweight or losing weight, recovery can be more difficult, and it can take longer for you to recover.

It is important to try and eat regularly, including snacks and nutritious drinks such as smoothies and milkshakes. Drinks and soups can be easier to eat if you are struggling with shortness of breath.

You should also try and limit the amount of alcohol you drink.

Stop smoking

If you currently smoke, it is important that you stop smoking as soon as possible. The longer you allow yourself between stopping smoking and your operation, the more your body can reduce the mucus creation and coughing that happens when you stop. This process can take several weeks.

Your anaesthesia and operation will be safer. It will also improve your body’s ability to heal, how well you recover from the anaesthetic and reduce your risk of complications after surgery.

Preparing your home

Before you go into hospital, it is a good idea to think ahead to when you are able to go back home. By being organised ahead of time, it will help reduce stress and let you concentrate on getting better.

You should also pack a hospital bag with the following:

• All medications and tablets that you are taking, in the correct container
• Two sets of nightwear (minimum). We recommend front-fastening pyjamas or loose-fitting tops
• Dressing gown and well-fitting slippers
• Toiletries
• Entertainment, such as magazine, books, music and tablet.

What happens during surgery?

Each hospital will have its own procedure for what when someone is having surgery.

When you settled in, your operation will be explained to you. Feel free to ask any questions you may have at this point.

You may not be allowed to eat or drink for several hours before your operation. This is to stop you from being sick during the anaesthetic.

You will be given special compression stockings to wear to help improve your circulation and prevent blood clots. You should continue to wear these until you have returned to your normal level of activity.

When it is time for your operation, you will be taken to theatre by a member of staff. The theatre staff will check your details and then take you into the anaesthetic room. You will have a small needle inserted into the back of your hand. This will be used to give you the medication that will help you fall asleep.

The theatre staff may also start a drip to stop you from becoming dehydrated and if necessary, catheter to enable you to pass water easily and monitor your urine output.

After the operation, you will go to the recovery room. This is where you will up from your anaesthetic. When the doctors and nurses feel you are ready to leave the recovery area, you will then be taken to a ward, high dependency unit or intensive care unit.

Once the nurses have set up the monitoring equipment and you are comfortable, you will be allowed to have visitors.

Recovery from surgery

Everyone will recover differently. It is likely you will be uncomfortable after surgery. Let the nurse or doctor know if you have any pain. You may also feel fatigued or tired for several weeks after surgery and a little short of breath.

It will take two to three weeks for your wounds to heal. It is quite common for there to be some numbness around any scars. Any non-dissolvable stitches, clips or staples may need to be taken out by your GP or nurse.

As soon as you are out of bed, you should start to move about to help your lungs start working properly again. Once you are steady on your feet, walk around for as long as you feel comfortable.

When you are able to go home will depend on several factors:

• Your level of fitness
• The type of operation you have had
• Whether you have had any complications
• You are able to eat and drink.

Hospital stays tend to last between 2 and 10 days, with an average of 3-5 days. Once at home, you should continue to walk regularly, gradually increasing distance and pace.

As you recover, you may experience some side effects, including:

• Breathlessness
• Constipation
• Cough
• Pain
• Weight loss / Change in appetite

Download our lung cancer surgery booklet for practical advice on dealing with these side effects.

Life after surgery

After you go home, you will usually be sent a follow-up appointment by the hospital. This will vary from hospital to hospital but is usually after two to six weeks. At this appointment, you will be given the results of your operation.

If you are looking to go on holiday, you should ask your surgeon about your fitness to fly during your first outpatient appointment.

You will then have further follow ups over a period of five years. This is called lung cancer surveillance. How often you are followed up will depend on your hospital’s local policy.

It’s understandable that you will be keen to get back to your ‘normal’ life as soon as possible after surgery.

Speak to your doctor about when you can start to drive again. You must be able to do an emergency stop without pain. You should also check if your insurance is affected.

You should also talk to your doctor about when you will be fit enough to return to work. Returning to work may take anywhere between one to three months and will depend on how quickly you recover from the operation.  It will also depend on what type of work you do and how physically demanding it may be.