Surgery for lung cancer
People with early non-small cell lung cancer (NSCLC) (stage 1 or 2) will generally be offered surgery to remove the tumour. How much of the lung is removed depends on several factors:
- the location of the cancer and its size
- your general wellbeing and fitness
- how your lungs are working (lung function).
Because lung cancer causes vague symptoms in the early stages, it is usually diagnosed at a later stage. Surgery is not suitable for most people with late-stage lung cancer. If there is fluid in the lung cavity (called pleural effusion) that keeps coming back, you may have surgery (pleurodesis) to control this.
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Surgery for lung cancer may remove all or part of a lung.
|One lobe of a lung is removed.|
|One whole lung is removed.|
|Only part of a lobe is removed.|
Most hospitals in Australia have programs to reduce the stress of surgery and improve your recovery. These are called enhanced recovery after surgery (ERAS) or fast track surgical (FTS) programs. They tell you what to expect each day after surgery.
During surgery, lymph nodes near the cancer will also be removed to check whether the cancer has spread. Knowing if the cancer has spread to the lymph nodes also helps the doctors decide whether you need further treatment with chemotherapy or radiation therapy.
There are different ways to perform surgery for lung cancer. Each method has advantages in particular situations – talk to your surgeon about the best approach in your case.
Lung cancer surgery can often be done using a keyhole approach. This is known as video-assisted thoracoscopic surgery (VATS). In this approach, the surgeon makes a few small cuts (incisions) in the chest wall. A tiny video camera and operating instruments are passed through the cuts, and the surgeon performs the operation from outside the chest. A keyhole approach usually means a shorter hospital stay, faster recovery and fewer side effects.
If a long cut is made between the ribs in the side of the chest, the operation is called a thoracotomy. This may also be called open surgery. You will need to stay in hospital for 3–7 days.
Tubes and dripsYou will have several tubes in place, which will be removed as you recover. A drip inserted into a vein in your arm (intravenous drip) will give you fluid, medicines and pain relief. There may be one or two tubes in your chest to drain fluid and help your lungs expand again. There may be a tube placed into your bladder to check how much urine you pass.
PainYou may have some pain or discomfort after surgery, but this can be controlled. Managing the pain will help you to recover and move around more quickly and allow you to do your breathing exercises. Pain will improve when tubes are removed from the chest. Pain relief may also help clear phlegm from your chest.
Recovery timeYou will probably go home after 3–7 days, but it may take 6–12 weeks to get back to your usual activities. Your treatment team will explain how to manage at home. Walking can improve fitness, clear your lungs and speed up recovery.
Exercises for breathlessnessGentle exercises as part of a pulmonary rehabilitation program will help improve breathlessness and reduce the risk of developing a chest infection. The hospital physiotherapist will show you how to do these exercises. To continue with a pulmonary rehabilitation program after you leave hospital, talk to your surgeon or visit Lung Foundation Australia.
See our general section on Surgery for more information about surgery and recovery.
Podcast: Making Treatment Decisions
A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Private Hospital Melbourne, VIC; Prof Kwun Fong, Thoracic and Sleep Physician and Director, UQ Thoracic Research Centre, The Prince Charles Hospital, and Professor of Medicine, The University of Queensland, QLD; Renae Grundy, Clinical Nurse Consultant – Lung, Royal Hobart Hospital, TAS; A/Prof Brian Le, Director, Palliative Care, Victorian Comprehensive Cancer Centre – Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, and The University Of Melbourne, VIC; A/Prof Margot Lehman, Senior Radiation Oncologist and Director, Radiation Oncology, Princess Alexandra Hospital, QLD; Susana Lloyd, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Nicole Parkinson, Lung Cancer Support Nurse, Lung Foundation Australia.
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