Surgery
Surgery is an operation to remove the tumor. It is most commonly used in early stage non-small cell lung cancer (NSCLC), and only occasionally in small cell lung cancer (SCLC). For patients with early stage lung cancer, surgical removal of the tumor and the lung tissue surrounding the tumor is the standard of care. If the tumor is too large for surgery at diagnosis, many lung cancer patients will receive radiation and/or chemotherapy (neo-adjuvant therapy) to shrink the tumor before the surgery is performed.
The type of surgery depends on the tumor’s location, its size, the type of lung cancer, and the stage of the lung cancer. There are two surgical procedures that are used to remove lung tumors.
- Thoracotomy: The traditional open surgery in which a large incision is made in the chest to remove lung tissue.
- VATS (video assisted thoracic surgery): A newer surgical procedure that requires two to four small incisions through which a video camera and smaller instruments are inserted to remove tissue.
During each of these procedures, one of the following will occur:
- Wedge resection: The removal of the tumor as well as a small amount of normal lung tissue (the margin).
- Segmental Resection – The surgical removal of the part of the lobe of the lung where the tumor is located along with its draining lymph nodes.
- Lobectomy: The surgical removal of an entire lobe of the lung. The right lung is divided into three lobes; the left lung has two lobes.
- Bilobectomy: The surgical removal of two lobes of the right lung.
- Pneumonectomy: The surgical removal of an entire lung.
Thoracotomy
A thoracotomy is five to ten inch incision on the chest, typically under the shoulder blade, but its location varies somewhat by surgeon. The underlying muscles are either split or divided and the ribs are spread apart with a retractor to give the surgeon access to the chest cavity and tumor.
Patients having a thoracotomy are completely asleep (general anesthesia) and are placed on their side. Using a special tube inserted into the windpipe (trachea) the lung being operated on is deflated or collapsed, while the other one is inflated with the assistance of a mechanical device called a ventilator.
Once the surgery is completed, the operated lung is reinflated and the chest is repaired by closing the ribs, muscles and skin with sutures. One or two drainage tubes are left in place to evacuate air and fluid. These tubes are usually removed after 3-5 days.
The first day after surgery may be spent in the intensive care unit of the hospital. A variety of tubes, catheters, and monitors may be required after surgery to monitor heart rate, blood pressure and oxygen saturation. The usual hospital stay after a thoracotomy is 4-6 days.
What is VATS?
Video-assisted thoracic surgery (VATS or thoracoscopy) enables doctors to view and work inside of the chest cavity after making between two and four small incisions (cuts). Typically, one incision is about two and a half inches long and the others are a half-inch long. A tube with a small video camera on its end is inserted through one of the incisions.
Video captured from inside the chest is transmitted onto a computer monitor in the operating room allowing the surgeon to see a magnified view of the chest structures. The surgeon uses special long instruments to perform the lung resection through the other incisions. No rib spreading is needed. As a result, wedge resections, lobectomies and even in some cases, pneumonectomies can be accomplished.
Patients are asleep (general anesthesia) and placed on their side during the surgery. Once the surgery is completed, the incisions are closed with sutures and one or two chest tubes are used to drain the chest. Chest tubes are removed one to two days after surgery. Most VATS patients are in the hospital for one day for a wedge resection and three days for a lobectomy.
Am I a candidate for VATS?
Not all lung cancer patients are candidates for VATS lobectomy. The procedure may not be appropriate in cases involving large tumors (larger than 7 centimeters), tumors that are growing into the chest wall, or tumors that involve the central airway (main bronchial tubes). Previous thoracic surgery or benign enlargement of lymph nodes is not a contraindication to VATS surgery.