Surgery or surgical resection is often used to remove a tumor. For early stage lung cancer, the preferred treatment for otherwise healthy patients is a lobectomy, in which the surgeon removes a lobe of the lung. Lobectomies can be performed in two ways. One method is called a thoracotomy, in which the ribs are cut and spread to allow the surgeon to access the lobe of lung that needs to be removed. The second type of lobectomy is less invasive and done using video-assisted thoracoscopic surgery (VATS). During this procedure, small incisions are made and a camera is placed in the chest to guide the surgeon performing the surgery. Some patients with early stage lung cancer may not require that an entire lobe be removed. This procedure is called a wedge resection or segmentectomy, and can reduce the amount of normal lung tissue removed.
To be effective as possible, lung cancer surgery must not only remove the visible tumor, but eliminate any microscopic traces of the disease that remain in the surrounding tissue. Studies comparing lobectomies to wedge resections have shown that the lobectomy results in better survival rates and is more effective in removing all of a patient’s disease.
For those patients whose primary lung cancer is more advanced, as well as those who have large tumors or multiple metastatic tumors that cannot be removed by lobectomy or segmentectomy, more extensive surgery is required. In these cases, surgeons may perform a pneumonectomy, during which the entire lung is removed.
Although surgery is effective for some stages of lung cancer, patients can experience significant risk of complications, including infection, bleeding, and respiratory and cardiac problems. These complications can also lead to loss of lung function and/or a decreased quality of life. Open lobectomy and VATS have local control rates and 5-year survival rates of 60-80%.
Lung cancer surgery is typically used alone for patients with very small tumors and early-stage lung cancer. However, some patients may not be well enough to undergo surgery because they suffer from other cardiac or breathing problems. For later stages of lung cancer, typically stage II and higher, surgery is often combined with chemotherapy and, perhaps, radiation therapy.