Types of surgery for lung cancer

Surgery for lung cancer is done in a specialist centre, and is carried out by specialist lung surgeons.

Types of surgery for lung cancer include removing:

• one lobe (lobectomy)
• two lobes (bilobectomy)
• the whole lung (pneumonectomy)
• a section of the lung (wedge, segmentectomy)
• lymph nodes

What type of lung surgery do I need?

The type of surgery you need for lung cancer depends on:

• the size of the cancer
• the position of the cancer in the lung
• the type of lung cancer (small cell or non small cell lung cancer)
• whether it has spread

Removing lobes of the lung

The lungs are divided into sections called lobes. There are 2 lobes in the left lung and 3 in the right lung.

Removing one lobe (lobectomy)

Lobectomy means removing one lobe of the lung. Your surgeon will recommend this type of operation if the cancer is just in one part of one lung. It is the most common type of operation for early stage lung cancer.

Removing two lobes (bilobectomy)

This means removing two lobes of the lung.

Removing the whole lung

The operation to remove the whole lung is called a pneumonectomy (new-mon-ek-tom-ee). Your specialist will recommend this operation if the cancer is in the central area of the lung and involves either the 2 lobes in the left lung or the 3 lobes in the right lung.

After a pneumonectomy, you might find doing certain things harder than before. Some people find demanding physical activity more difficult than before. You may also find that you become more breathless than before.

Your doctor will arrange for you to have breathing tests before the surgery to help decide if this operation is right for you.

Removing a section of lung

Some operations remove particular areas of the lung. You might have these types of operation if the cancer:

• has been diagnosed early
• is only in one very small area

If your specialist thinks the cancer cells could be anywhere else in the lung they won’t recommend this type of operation.

Wedge resection

A wedge resection removes an area of the lung that includes part of one or more lobes.

Segmentectomy

A segmentectomy removes areas of the lung along with their veins, arteries and airways.

Sleeve resection

You might have an operation called a sleeve resection if your cancer is in the central area of the lung and growing into one of your main airways (bronchi). Your surgeon removes the affected section of the airway and any surrounding cancer in the lobe. This operation is not as common as other types of lung cancer surgery.

Removing lymph nodes

During your operation the surgeon examines the lung and surrounding area. They take out some of the nearby lymph nodes in case they contain cancer cells that have spread from the main cancer. This is called lymphadenectomy. The number of lymph nodes your surgeon removes varies.

If the lymph nodes contain cancer cells your doctor usually recommends that you have chemotherapy after your surgery.

How you have your operation

To remove your lung cancer, you might have open surgery (thoracotomy or sternotomy) or keyhole surgery.

Thoracotomy

Your surgeon makes a cut that runs around the side of the chest. This is called a thoracotomy. Sometimes the cut may only be a few centimetres long. But it can also be longer and run from under the nipple around to your back under the shoulder blade.

Sternotomy

During a sternotomy, your surgeon makes a cut through the length of the breastbone (sternum). It gives them access to both the left and right sides of the chest.

Keyhole surgery

Keyhole surgery can remove small, early, non small cell lung cancers. The medical name for this operation is video assisted thoracoscopic surgery (VATS). The surgeon makes 1, 2 or 3 small cuts on the side of your chest. They use a long, bendy tube called a thoracoscope.

Having keyhole surgery

The thoracoscope connects to a fibre optic camera. This shows pictures of the inside of the chest on a video screen. The surgeon puts the surgical instruments into the other cuts to remove the cancer.

Robotic assisted thoracic surgery (RATS)

This surgery uses a computer system to help the surgeon to guide the surgical tools. RATS might not be available at all hospitals.