Treatment of lung cancer is stage dependent. For complete information on cancer staging, go to the American Joint Committee on Cancer.
If surgery is recommended, the type and extent of surgery will depend on the patient's specific stage, location, and form of cancer. The larger the nodule, the more lung tissue needs to be removed. A lung resection is a surgical procedure to remove a damaged or diseased portion of a lung, or a whole lung. Lung resection surgery offers the best opportunity for curing lung cancer when the disease is caught in its early stages.
In some cases, surgical removal may not be an option. For those patients who are candidates for lung resection surgery, a range of approaches is available. Whenever possible, we prefer to use minimally invasive techniques that reduce pain and aid in the patient's recovery.
Lobectomy: Video-Assisted Thoracoscopic Surgery (VATS)
In this technique, the surgeon makes two or three one-inch incisions between the ribs. A camera attached to a telescope (which magnifies the field of view), is placed in one of the incisions. The camera is used to examine the entire chest cavity, including portions of the lung. The surgeon then excises the nodule and gives it to the pathologist to examine under a microscope. If the nodule is cancerous, the surgeon can remove the entire lobe where the cancer has grown.
A VATS lobectomy offers a significant advantage to the patient because it reduces both the recovery period and the amount of postoperative pain, lowering the need for pain medications. Patients who undergo this procedure return to normal activities much faster than those who undergo a more extensive lobectomy performed through a thoracotomy incision.
Read more about video-assisted thoracoscopic surgery (VATS).
After neoadjuvant therapy or if the tumor is very large, a thoracotomy may be required. A thoracotomy incision is made between the ribs. It extends from the patient's side, under the arm, and up the back. The incision extends for about eight to nine inches. It requires dividing some chest wall muscles and spreading the ribs. If a thoracotomy incision is required to remove the lung cancer, our surgeons are able to perform the surgery with far less patient discomfort than was possible a decade ago. All of our patients are given an epidural catheter through which we provide postoperative pain medication. The pain relief from the epidural is quite effective. Patients are able to get out of bed on the first day after surgery and walk around as required.
Occasionally, if the cancer is quite large or very central in the lung — close to where the major bronchus separates from the trachea — the only way to completely remove the cancer is to take out the entire lung. This procedure is referred to as a pneumonectomy. When you remove the entire lung, you obviously eliminate more viable lung tissue as well. A higher complication rate, therefore, is associated with this procedure. We try not to remove the entire lung unless absolutely necessary to try to cure the cancer.