Types of surgery

Surgery for lung cancer is done in a specialist centre, and is carried out by specialist lung surgeons.

What type of surgery do I need?

The type of surgery you need for lung cancer depends on:

• the size of the cancer
• the position of the cancer in the lung
• the type of lung cancer (small cell or non small cell lung cancer)
• whether it has spread

Non small cell lung cancer 

Surgery is mostly used to treat non small cell lung cancer. But surgery might not be suitable for you if your cancer is very near any of the following structures:

• the heart
• the windpipe
• the food pipe (oesophagus)
• major blood vessels

In this situation, your doctor might recommend other cancer treatments instead of surgery, such as radiotherapy, chemotherapy or immunotherapy.

Small cell lung cancer 

Surgery is not normally used to treat small cell lung cancer, unless it is at a very early stage. Small cell lung cancer has usually spread beyond the lung when it is diagnosed and so it is not possible to remove it all with surgery. It is more common to have chemotherapy and radiotherapy rather than surgery for small cell lung cancer. You may be offered immunotherapy. 

Types of lung surgery

There are different types of lung surgery. You might have one of the following:

Removing one lobe (lobectomy)

The lungs are divided into sections called lobes. There are 2 lobes in the left lung and 3 in the right lung.

Lobectomy means removing one lobe of the lung. Your surgeon will recommend this type of operation if the cancer is just in one part of one lung. It is the most common type of operation for lung cancer.

Removing two lobes (bilobectomy)

This means removing two lobes of the lung.

Removing the whole lung

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

Many people worry that they won't be able to breathe properly with only one lung. If you have good lung function test results before surgery then you should be able to 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. You might have these types of operation if the cancer:

• has been diagnosed early
• is only in one very small area

If your specialist thinks the cancer cells could be anywhere else in the lung they won’t recommend this type of operation.

Wedge resection

A wedge resection removes an area of the lung that includes part of one or more lobes.

Segmentectomy

A segmentectomy removes areas of the lung along with their veins, arteries and airways.

Sleeve resection

You might have an operation called a sleeve resection if your cancer is in the central area of the lung and growing into one of your main airways (bronchi). Your surgeon removes the affected section of the airway and any surrounding cancer in the lobe. This operation is not as common as other types of lung cancer surgery.

Removing lymph nodes

During your operation the surgeon examines the lung and surrounding area. They take out some of the nearby lymph nodes in case they contain cancer cells that have spread from the main cancer. This is called lymphadenectomy. The number of lymph nodes your surgeon removes varies.

If the lymph nodes contain cancer cells your doctor usually recommends that you have chemotherapy after your surgery.

How you have your operation

To remove your lung cancer you might have open surgery or keyhole surgery. Most people have open surgery.

Open surgery

Your surgeon makes a cut that runs around the side of the chest. This is called a thoracotomy. Sometimes the cut may only be a few centimetres long. But it can also be longer and run from under the nipple around to your back under the shoulder blade.

Keyhole surgery

Keyhole surgery can remove very small, early, non small cell lung cancers. The medical name for this operation is video assisted thoracoscopic surgery (VATS). The surgeon makes 1, 2 or 3 small cuts on the side of your chest. They use a long, bendy tube called a thoracoscope.

Having keyhole surgery

The thoracoscope connects to a fibre optic camera. This shows pictures of the inside of the chest on a video screen. The surgeon puts the surgical instruments into the other cuts to remove the cancer.