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What Happens During Surgery for Lung Cancer

You may have another type of treatment before surgery to make the tumor smaller and easier to remove. If so, it’s called neoadjuvant therapy. You may have chemotherapy alone. Or you may have chemotherapy and radiation. The goal of either is to help shrink the tumor so that it is easier to take out. There is usually a four-week break after the radiation before the surgery.

On the day of your surgery, an anesthesiologist or a nurse anesthetist will give anesthesia. This drug makes you fall asleep and not feel pain during the operation. Before surgery, you can ask questions about how the anesthesia will affect you.

The type of surgery you have depends on your health condition and stage of the tumor. The doctor may remove part or all of the affected lung. These are the main types of lung surgery to remove cancer. For these operations, the surgeon usually makes an incision in the side of the chest wall and reaches the lung between the ribs. This is known as a thoracotomy. 

  • Lobectomy. This type of surgery removes only the section of the lung, called the lobe, that the cancer is in. It is the most common surgical procedure done for lung cancer that’s only in one lobe of the lung. The parts of the lung that are left expand to fill in the space. During a lobectomy, your surgeon may also remove some of the nearby lymph nodes.

  • Wedge resection or segmentectomy. This is the most conservative type of surgery for lung cancer. It is done in people who cannot tolerate more extensive surgery. For instance, if you have emphysema, your lungs won’t expand well after a lobectomy. With a wedge resection, your surgeon removes only the tumor itself and a small portion of lung around it, not the entire lobe. With a segmentectomy, the surgeon removes a slightly larger section of the lung. The chances of the lung cancer coming back are higher with this type of surgery than with a lobectomy.

  • Pneumonectomy. This type of surgery was once the standard treatment for lung cancer. During this surgery, the entire lung that is affected is removed. Now, surgeons only do a pneumonectomy if the tumor cannot be completely removed with a lobectomy.

  • Sleeve resection. This surgery is sometimes used if the cancer is in a large airway (bronchus) near where it enters the lung. The section of the bronchus containing the cancer is removed and the lung is reattached to the remaining bronchus. This allows the surgeon to avoid having to remove the whole lung. 

Video-assisted thoracic surgery (VATS) is a newer, and less invasive procedure for treating early stage lung cancer, especially tumors smaller than 3 to 4 centimeters. Instead of making a large incision (thoracotomy), specially trained surgeons place a thin tube with a small video camera on the end through a small opening in the side of the chest. Two or three other small openings are made in the chest to allow the doctor to insert instruments to remove the tumor. This procedure usually involves less pain after surgery and a shorter hospital stay. The cure rate after VATS appears to be similar to other surgical methods, but it is important that it is done by a surgeon experienced with this technique.  

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