What are the different types of surgery for lung cancer?

Dr. Raja M. Flores, MD
Cardiothoracic Surgeon

The majority patients will require a lobectomy surgery for lung cancer. In this video, Raja Flores, MD, thoracic surgeon at The Mount Sinai Medical Center, explains the different surgeries for lung cancer.

Dr. Daniel A. Nader, DO
Pulmonary Disease Specialist

Surgical lung resection is one type of surgery lung cancer patients can undergo. The percentage of patients who have adverse events associated with surgery is small, as a result of proper staging and careful evaluation of a patient's lung function. The pulmonologist's role in lung cancer patients is to appropriately stage the patient to ensure that surgery is indicated and to assess their lung function and other potential disease states that might compromise the patient's health status after a surgical resection.

Types of surgery for lung cancer include a segmental resection, lobectomy, pneumonectomy, and video-assisted thoracoscopic surgery. Lung surgery is relatively safe but has risks including infection. Lung surgery patients are also at risk for pneumonia.

Four types of surgery (surgical resection) are used in the treatment of lung cancer:

  • Wedge or segmental resection: If the tumor is small enough, a surgeon may be able to treat it by removing the part of the lung that is affected. This type of surgery may also be used in people whose lung function does not allow for more lung tissue to be removed.
  • Lobectomy: An entire section (lobe) of the lung is removed. This is the most common operation performed for lung cancer.
  • Pneumonectomy: Removal of the entire lung.
  • Video-assisted thoracoscopic surgery (VATS): A minimally invasive surgery used to treat the early stages of lung cancer.

There are cases where initial surgery is not recommended for lung cancer. (Other types of surgery still may be used to relieve symptoms, however.) For example, when:

  • cancer has spread to the other lung
  • cancer has grown from the lung into mediastinal lymph nodes or other organs in the chest
  • cancer has spread to the lymph nodes in the neck or to other organs, such as the liver, bones or brain
  • there are other health-related problems that make major surgery unsafe

Surgical lung resection, in which part of a lung is removed, can be a safe and effective surgical treatment option for high-risk patients with early stage lung cancer. At three years’ post-surgery, researchers found that 59 percent of high-risk patients were still alive, and 76 percent of standard-risk patients had survived.

The research team identified 490 patients who underwent surgical resection for early stage lung cancer from 2009 through 2013. The patients were classified as standard risk (310 people) or high risk (180 people), based on previously published criteria.

The researchers evaluated outcomes and survival following surgery and found that the overall length of hospital stay was longer for high-risk patients (five days) compared to standard-risk patients (four days), but there was no difference among the two groups in post-operative mortality (2 percent for high-risk patients; 1 percent for standard-risk patients).

Importantly, about 20 percent of the patients had cancer that had spread to their lymph nodes, a finding that was unexpected based on the pre-operative imaging tests. This group of patients was able to undergo chemotherapy, which is an important adjunct treatment for their cancer stage. This spread of cancer to the lymph nodes would not have been discovered and accordingly treated through a non-surgical approach.

This shows that surgical resection is an acceptable treatment option with good results for patients with early stage lung cancer who have been identified as high-risk for surgery. High-risk patients have a new treatment avenue that previously may have been denied to them. A multidisciplinary team should review each case to determine the best treatment plan for individuals with lung cancer.

Dr. Vijay K. Nuthakki, MD
Cardiothoracic Surgeon

There are several options for surgical treatment of lung cancer. The standard operation is a lobectomy and this can be performed via the standard thoracotomy or more recently with thoracoscopy. Based on the specifics of the tumor and its involvement, a pneumonectomy (removal of the entire lung on one side) may be performed. In some patients, a lesser amount of lung can be removed via a wedge resection or segmentectomy. In patients who cannot tolerate a lobectomy for lung cancer, they may be candidates for wedge resection and brachymesh placement. In some cases, patients may also need to have a portion of their chest wall, pericardium, or diaphragm removed with the tumor.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.