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Types of surgery for lung cancer

Surgery is mostly used to treat non small cell lung cancers. It is not normally used to treat small cell lung cancer.

If your cancer is very near your heart, windpipe, food pipe (oesophagus) or a major blood vessel, it may be better for you to have other treatments. Your doctor may suggest chemotherapy or radiotherapy instead. If you have other health problems such as a severe heart condition or other lung disease, you may not be fit enough to have major lung surgery.

There are three main types of surgery used to treat lung cancer. These are

  • Removing a section of lung
  • Removing a lobe of the lung (lobectomy)
  • Removing the whole lung (pneumonectomy)

During your operation your surgeon will remove some of the lymph nodes from around the lung. The surgeon sends the lymph nodes to the laboratory where they are examined under a microscope. If the nodes contain cancer cells this may affect the treatment that you need after the surgery. 

Keyhole surgery is sometimes used to remove early, small non small cell lung cancers. In this type of surgery the surgeon removes the cancer through several small cuts rather than 1 larger wound. 

If your cancer has spread

A major operation to remove your cancer will not be the right treatment for you if your cancer has spread to anywhere else in your body . Your doctor will probably suggest another type of treatment such as chemotherapy and radiotherapy instead.

 

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Surgery for lung cancer

Surgery is mostly used to treat non small cell lung cancer. But it may be better for you to have other cancer treatment such as radiotherapy, chemotherapy or possibly both if your cancer is very near any of the following structures

  • Heart
  • Windpipe
  • Food pipe (oesophagus)
  • Major blood vessels

Surgery is not normally used to treat small cell lung cancer, except if it is at a very early stage. This is because small cell lung cancer has usually spread beyond the lung when it is diagnosed and so it is not then possible to remove it all with surgery. Chemotherapy and radiotherapy are more often used than surgery for small cell lung cancer.

The type of surgery you have will depend on the size of the cancer and its position within the lung.

 

Removing lobes of the lung

Lobectomy is the removal of one lobe of the lung. Your surgeon will recommend this type of operation if they think the cancer is just in one part of one lung. It is the most common type of operation for lung cancer. Bilobectomy is the removal of two lobes of the lung.

Diagram showing the removal of one lobe of the lung (lobectomy)

Diagram showing the removal of two lobes of the lung (bilobectomy)

A small number of people with lung cancer have an operation called a sleeve resection. Your surgeon may do this to avoid removing your whole lung if the cancer is in the central area of the lung and is growing into one of your main airways (bronchi). In this situation a simple lobectomy can't be done. Sleeve resection involves removing the affected section of the bronchus, and any surrounding cancer in the lobe.

 

Removing the whole lung

Doctors call the operation to remove the whole lung a pneumonectomy (new-mon-ek-tom-ee). Your specialist will recommend this operation if the tumour is in the central area of the lung and involves either the 2 lobes on the left or the 3 lobes on the right.

Diagram showing the removal of a whole lung (pnuemonectomy)

Many people worry that they won't be able to breathe properly with only one lung but you can breathe normally with only one lung. If you had breathing problems before the operation, you will probably still be breathless afterwards. Your doctor will arrange for you to have breathing tests before the surgery to help decide if this operation is right for you.

 

Removing a section of lung

Some operations remove particular areas of the lung. A wedge resection removes an area of the lung that includes part of one or more lobes. A segmentectomy removes areas of the lung along with their veins, arteries and airways. These types of operation are used when the specialist thinks the cancer has been diagnosed early and is only in one very small area. If the specialist thinks the cancer cells could be anywhere else in the lung they will not recommend this type of operation.

 

Keyhole surgery for lung cancer

Surgeons can sometimes use keyhole surgery to remove very small, early, non small cell lung cancers. This type of surgery is called video assisted thoracoscopic surgery (VATS).

The surgeon passes a flexible tube with a telescopic camera through a small cut in the chest. This allows them to examine the lungs under video guidance. They then make 1, 2 or 3 small cuts (incisions) on the side of the chest. They insert the surgical tools through the cuts to carry out the surgery.

Diagram showing video assisted thoracoscopy (VATS)

 

Removing lymph nodes

During your operation your surgeon will remove some of the lymph nodes from around the lung. This is because the lymph nodes may contain cancer cells that have broken away from the main cancer. The surgeon sends the lymph nodes to the laboratory where they are examined under a microscope. If the nodes contain cancer cells this may affect the treatment that you need after the surgery. 

 

If your cancer has spread

A major operation is unlikely to be the right treatment for you if your cancer has spread to anywhere else in your body. If there are cancer cells anywhere else, the operation will not remove them and your doctor will probably suggest another type of cancer treatment such as chemotherapy and radiotherapy instead.

 

Your general health

If you have other health problems such as a severe heart condition or other lung disease, you may not be fit enough to have major lung surgery. Your surgeon will examine you thoroughly and do quite a few tests before you decide together whether an operation is right for you and which type of operation.

Your doctor may recommend radiotherapy instead of surgery and you can find information about this in our section about radiotherapy for non small cell lung cancer.

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Updated: 28 March 2014