Understanding Your Procedure
Lung Cancer Surgery
Lung cancer is a serious condition that affects the lungs, causing symptoms such as difficulty breathing, coughing up blood, chest pain, and weight loss. If you’ve been diagnosed with non-small cell lung cancer (NSCLC), you are likely to be offered surgery as part of your treatment plan. Here we’ll explore the different types of lung cancer surgery, lymph node sampling, risks, benefits, expected recovery, and possible post-operative complications.
Discuss your concerns
Understanding the different types of surgery, risks, benefits, and expected recovery will empower you to make informed decisions.
Types of Lung Cancer Surgery
Lobectomy
- Description: Lobectomy involves removing one of the lobes of the lung; approximately 30% to 50% of the lung tissue is removed.
- Indications: Commonly performed for lung cancer, especially when the tumor is localized within a single lobe.
- Benefits: Effective in removing cancerous tissue while preserving lung function.
- Risks: Bleeding, infection, and general pain from the surgery.
- Recovery: Typically takes several weeks to months.
Segmentectomy
- Description: Only part of one lobe of the lung is removed, preserving more lung tissue.
- Indications: Recommended for treating early-stage lung cancer, including:
- Stage 0 NSCLC (non-small cell lung cancer) depending on tumor location.
- Stage 1 NSCLC if the tumor is very small.
- Lung carcinoid tumors.
- Lung metastases from other cancers.
- Removal of noncancerous growths.
- Benefits: Removes the tumor while preserving more healthy lung tissue, which can be crucial for patients with compromised lung function.
- Risks: May include atelectasis (partial lung collapse), or pleural effusion (fluid accumulation around the lung).
- Recovery: Expect some reduction in lung function; individual outcomes may vary based on overall health, pre-existing conditions, tumor staging, and other factors
Bilobectomy
- Description: This surgery removes two adjacent lobes of the lung.
- Indications: Used when the tumor has spread to two neighboring lobes.
- Benefits: Ensures complete removal of affected tissue.
- Risks: Similar to lobectomy.
- Recovery: Longer recovery time due to the extent of tissue removal.
Pneumonectomy
- Description: The entire lung is removed.
- Indications: When the tumor is near the airways or affects more than one lobe.
- Benefits: Eliminates cancerous tissue but leaves the patient with only one lung.
- Risks: Breathing difficulties, bleeding, and infection.
- Recovery: Requires significant time for adjustment.
Wedge Resection:
- Description: Involves removing a small part of a lung lobe in a non-anatomical way.
- Indications: Used primarily for small sized tumors located near the lung surface.
- Benefits: Minimally invasive, preserving lung function, while still able to remove a portion of the lung containing a tumor, and some surrounding tissue.
- Risks: Minimal compared to other surgeries.
- Recovery: Faster recovery due to less tissue removal.
Lymph Node Sampling
During surgery for lung cancer, lymph node sampling or dissection (removal of the entire lymph node) is routinely performed. Lymph nodes play a crucial role in cancer staging and prognosis. By examining nearby lymph nodes, it can be determined if cancer has spread beyond the lung. Lymph node sampling helps guide further treatment decisions.
Operative Techniques
Robotic-Assisted Thoracoscopic Surgery (RATS)
RATS employs robotic arms controlled by the surgeon. This approach enhances precision and dexterity during minimally invasive procedures. The robotic system mimics human movements with greater accuracy, allowing for precise dissection. Surgeons operate from a console, reducing physical strain. RATS is particularly useful for lung cancer resections, including lobectomy and segmentectomy, as well as mediastinal masses. However, it comes with drawbacks. The cost is higher due to the robotic system, and there is a learning curve for surgeons. Contraindications include severe cardiopulmonary disease and limited access due to obesity or anatomical constraints.
Video-Assisted Thoracoscopic Surgery (VATS)
VATS is a minimally invasive technique. It involves small incisions (usually 2-4) through which a camera and specialized instruments are inserted. The surgeon visualizes and manipulates the chest cavity using video guidance. VATS offers several advantages: reduced invasiveness, minimal postoperative pain, and faster recovery. Patients often go home sooner, and the cosmetic benefit includes minimal scarring. However, VATS has limitations. The visibility is limited, making it challenging for complex cases or tumors in specific locations. Surgeon expertise significantly impacts outcomes. VATS is indicated for early-stage lung cancer and smaller tumors, while contraindications include extensive adhesions or centrally located tumors.
Thoracotomy
Thoracotomy is a traditional open surgical approach. During this procedure, a larger incision (usually made between the ribs) provides direct access to the chest cavity. The surgeon gains excellent visibility of the lung and surrounding structures. Thoracotomy is preferred for complex cases, such as large tumors or multiple nodules. However, it has significant drawbacks. The invasiveness of rib spreading leads to substantial postoperative pain, and patients require a longer hospital stay. Additionally, the risk of complications is higher. Thoracotomy is indicated for extensive tumor removal and complex cases but is contraindicated for high-risk patients or those prone to complications.