Types of Lung Cancer Surgery: What to Expect and How to Lower Your Risk for Complications

Lung cancer is a type of cancer that starts in or spreads to the lungs. Lung cancer is the No. 1 type of cancer that kills both men and women, according to the Centers for Disease Control and Prevention. However, lung cancer that’s detected early enough can be treated and is associated with higher rates of survival.

Treatments for Lung Cancer

Treatments for lung cancer include:

— Chemotherapy.

— Immunotherapy. This has a huge impact on survival rates.

— Radiation.

— Surgery.

— Targeted therapy, which is a newer approach that uses medicines to slow or stop the growth of cancer cells. Targeted therapy is thought of as a form of chemotherapy, but it targets cancer cells more specifically than regular chemotherapy, which kills a broader range of both healthy and cancerous cells.

Lung cancer is divided into stages to indicate its severity. Stage 0 is not life threatening or invasive. Stages 1 and 2 are early stages usually treated by surgery. Stage 3 is locally advanced, placing it in the middle, and stage 4 is the most advanced stage, usually spread to other organs.

Early Stages

For early cancers, surgery to remove the tumor is the most common and often the only treatment, says Dr. Jobelle Baldonado, a thoracic surgeon at Moffitt Cancer Center in Tampa. By stage 2, surgery is still the main treatment, but it’s followed by other treatments.

Stage 3

Surgery is also used in stage 3 lung cancer, but it’s combined with other therapies. For stage 3 lung cancer, it’s under debate which type of treatment to do first, Baldonado says. Some stage 3 cancers can be considered for surgery, known as stage 3A. Stages 3B and 3C are treated by chemoradiation followed by immunotherapy. In this stage (stage 3), the surgeon is only focusing on what they can do, but most stage 3 patients are inoperable.

Stage 4

Surgery is not used often in stage 4 lung cancer because by then, the cancer has spread to other organs. “There are too many places to take it out,” explains Dr. Raphael Bueno, chief of the division of thoracic and cardiovascular surgery and co-director of Brigham and Women’s Lung Cancer at Brigham and Women’s Hospital in Boston.

However, adds Baldonado, lung cancer surgery in these stage 4 patients might be used if the cancer has spread to only one other location — such as the brain — and that location is responding well to therapy.

In advanced lung cancer, surgeons sometimes perform surgery to remove a tumor that may be causing pain because it’s invading the wall of the chest, or to remove sections of a lung destroyed with an infection, says Dr. Ara A. Vaporciyan, chair of the department of thoracic and cardiovascular surgery at the University of Texas MD Anderson Cancer Center in Houston. This is rare and considered palliative. Radiation is also an option to avoid surgery as it’s less invasive. The preferred treatment is usually systemic therapy, such as chemotherapy, targeted therapy and/or immunotherapy.

Doctors who treat cancer work as a team to help decide on the best treatment plan for patients, Vaporciyan says. That’s because the choice of treatments can get complex, so collaboration helps to consider all the factors needed for each individual patient.

[READ: Is It Lung Cancer or Something Else?]

How to Prepare for Lung Cancer Surgery

Lung cancer surgery can be hard on the body. There are a few things your health care team will want you to do to help prepare for the surgery. These steps can help your body stay strong for surgery and have better recovery afterward.

The pre-surgical prep includes:

Making sure your heart and other organs are strong enough to withstand surgery. Doctors will perform tests to determine this. Typically the clearance is provided by the patient’s primary care physician or cardiologist.

Testing your pulmonary function. This type of test reveals if the lungs can tolerate removal of a part of a lung or a full lung. This is the most important test, as poor lung function rules you out for surgery before the surgeon looks at anything else, and most of the patients ruled out are smokers with emphysema.

Getting your body in physical shape. Baldonado asks her patients to walk a mile a day in the month leading up to surgery. Alternatively, you can use a stationary bike or do another type of physical activity. This type of “prehab” helps with overall fitness and lowers the chance of complications like pneumonia after surgery.

Stopping the cigarettes. It’s less common nowadays for patients with lung cancer to still be smoking, although they may have smoked before, Vaporciyan says. However, for those who do still smoke, even one cigarette in the two weeks leading up to surgery can raise the risk for post-surgical complications like pneumonia. That’s why it’s important not to light up and to not be exposed to secondhand smoke.

Trying to avoid upper respiratory infections. Steer clear of others who are sick or those who may pick up infections easily, like young children.

Most surgeons will want you to fast before surgery to avoid the risk of throwing up when you get anesthesia. However, some surgical centers are changing this, Vaporciyan says. Some surgeons may say it’s OK for you to have a carbohydrate-heavy drink like Ensure to help your body feel a little more full prior to surgery. Ask your health care team for guidance.

In addition, some surgical centers start to give certain medicines such as pain medicines in advance of surgery, Vaporciyan says.

[READ: Exercise Is Key When Living With Lung Cancer.]

Types of Lung Cancer Surgery

Depending on the size of the cancerous tumor in the lung, your underlying lung function, your overall health and cancer staging, your surgeon will decide how much of your lung to remove. The options include:

Pneumonectomy: The entire lung is removed. This is not done very often.

Lobectomy: Removal of one or two lobes. The left lung has two lobes, and the right lung has three lobes.

Segmentectomy: A segment, which is part of the lobe, is removed.

Wedge resection: A wedge is the smallest part of the lung that can be removed. This involves removal of just the tumor and some of the tissue around it.

Lung cancer surgery is done under anesthesia.

Surgeons also typically remove the lymph nodes near the tumor during lung cancer surgery. An analysis of the lymph nodes helps to see if cancer is spreading beyond the lungs.

Lymph nodes are small structures that help to fight off infection. These are often described as dime-sized glands that are all over the body. They drain organs looking for infection, but they can drain cancer spread and lead to additional spreading. This is why lymph node sampling is the standard of care for accurate staging and treatment whenever possible.

It can be hard to judge whether cancer is spreading to the lymph nodes before surgery. A study of the lymph nodes can help determine next treatment steps, Bueno says.

The majority of lung cancer surgeries are done with a minimally invasive approach. This means that surgeons use smaller incisions and smaller instruments to perform the surgery. Sometimes, they may even control a machine called a robot to do the surgery. Minimally invasive surgeries have a faster recovery and fewer complications post-surgery.

In a smaller percentage of patients, the surgeon performs a thoracotomy, which is an open or traditional surgery. In this circumstance, the surgeon makes an incision on the side of the chest to perform the surgery. This may involve spreading the ribs or breaking a rib to remove the tumor. Open surgery is used for a larger tumor or if the entire lung must be removed.

Lung cancer surgery usually takes two to three hours. Surgical centers that frequently perform lung cancer surgery tend to finish surgery a little more quickly.

[Read: Lung Cancer vs. Metastatic Kidney Cancer: What’s the Difference?]

Post-Surgical Care for Lung Cancer

After you have surgery, hospital staff will try to get you on your feet and moving within a few hours after surgery. That’s because early movement is associated with better surgical outcomes.

Lung cancer surgery is associated with some postoperative pain, especially if you’ve had an open procedure and you’ve had a rib broken for the surgery. However, surgical centers have made changes to reduce reliance on the heavier opioid pain medications. Among Vaporciyan’s patients, for example, fewer than 20% who have had minimally invasive lung cancer surgery require opioid medication once they go home, he says.

During lung cancer surgery, the surgeon will usually insert a chest tube that helps to collect leaking air. This chest tube also may cause some pain. It’s typically removed while you’re still in the hospital. If you go home with a chest tube, doctors will remove the tube after a few more days.

Post-Lung Cancer Surgery Complications

In addition to pain, some complications associated with lung cancer surgery may include:

Pneumonia, which is an infection in the lungs.

Blood clots.

— Poor wound healing at the surgery site.

— Empyema, an infection of the chest cavity, is a type of pulmonary disease. Your lungs are housed in the chest cavity. Vaporciyan says you can think of your chest cavity like a box, and your lungs are like a balloon in that box. Sometimes, an infection occurs in the chest cavity area after surgery.

Atrial fibrillation, or an irregular heartbeat that develops usually between days two to four after surgery and is often temporary. If this occurs, you’ll probably still be in the hospital, so staff will monitor for it. You may feel heart palpitations, and you’ll receive medicine for it.

The typical hospital stay for lung cancer surgery is two to three days for minimally invasive surgery and three to five days for open surgery. Your risk for complications from surgery are lower once you return home, but you should still let your health care team know if you experience:

— A fever. Most patients will run a little hotter after lung cancer surgery, but if it’s trending toward 101.5 degrees F or higher, let a doctor know, Vaporciyan advises.

— Chest pain.

— Discharge from the incision site.

— Problems urinating.

— Shortness of breath.

Full recovery from lung cancer surgery usually takes four to six weeks, Baldonado says. Your body needs to get used to functioning without a portion of the lung or sometimes a full lung.

Bueno notes that the body won’t generate a new lung or lung parts in its place.

Survival With Lung Cancer

It’s normal to wonder about survival after lung cancer surgery. The earlier your cancer is detected and treated, the better chance you have at survival. That’s why lung cancer screening is recommended if you smoke or have a family history of lung cancer, Bueno says. There also are more treatments available now than ever before for lung cancer.

According to the American Cancer Society, five-year survival rates for non-small cell lung cancer (the most common type of lung cancer) are:

— Localized cancer, 63%.

— Regional, meaning the cancer has spread to lymph nodes or nearby structures, 35%.

— Distant, meaning it’s spread to other organs, 7%.

[Read: Mohs Skin Cancer Surgery Facts.]

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Types of Lung Cancer Surgery: What to Expect and How to Lower Your Risk for Complications originally appeared on usnews.com

Update 06/29/22: This story was previously published at an earlier date and has been updated with new information.

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