Lung Cancer Treatments

Treating lung cancer always begins with a discussion between you and your doctor. Once it’s been determined that surgery is your best option for treatment, it’s now important to get as much information as you can about the procedure. First, you may want to know something about the different types of procedures that may be performed. These include:

Wedge resection

When a surgeon removes a small piece, or “wedge,” of a lung that contains the cancerous tissues, along with a portion of the surrounding healthy tissue.

Lobectomy

When an entire lobe of a cancerous lung is removed. The lungs are made up of five different lobes (two lobes on the left and three lobes on the right). If one is removed, the lungs can continue to function with the remaining lobes.

Segmentectomy

When a “segment” that contains the cancerous tissue is removed from a lobe of the lung.

Pneumonectomy

When one entire lung is removed in order to treat the cancer. Since this procedure will greatly reduce the overall lung function, this surgery is only used when deemed absolutely necessary.

Different Approaches for Lung Surgery

One key difference in how these surgeries can be performed is the way in which the surgeon gains “access” to view the lungs. In a traditional approach, a long incision is made from front to back along one side of the chest. In order to view the lungs, the ribs are spread apart and, in some cases, a small piece of rib is removed. A patient may experience pain for several weeks or months after surgery.

A second approach uses a small video camera to allow the surgeon to view the lung area. This option, called Video-Assisted Thoracic Surgery (VATS), allows the surgeon to make smaller openings in the body. This minimally invasive procedure may offer benefits such as a lower risk of complications.³⁵

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Video Assisted Thoracic Surgery

In Video-Assisted Thoracic Surgery (VATS) a surgeon inserts an instrument with a tiny video camera into small openings in the body. In recent years, many thoracic surgeons who used to favor traditional "open" lung surgery (requiring a large incision) are now choosing VATS (with a few small incisions). This minimally invasive method can be used to perform complex procedures, such as taking tissue samples for diagnosis as well as removing sections or even the entire diseased lung. For patients with clinical stage 1 non-small cell lung cancer, some studies have shown VATS:

• Is associated with a 70% less risk for complications after surgery and 61% less chance of pulmonary (lung-related) complications when compared to "open" procedures (which require a large incision).³⁵
• May reduce recurring pain along with the need to treat chronic pain for longer than a year when compared to "open" procedures (which require a large incision).³⁵
• May require significantly less painkiller medication and for a shorter time period when compared with those undergoing "open" procedures (which require a large incision).³⁵

There are additional benefits that may be especially important for cancer patients. Depending on the type of surgery performed, VATS patients may be able to receive a more effective dose of chemotherapy after surgery.⁹⁶ And both approaches appear to be equally effective with 5-year survival rates for VATS patients having been shown to be the same as patients who undergo "open" surgery (which requires a large incision).³⁵

While many surgeons recommend VATS for lobectomies in lung cancer patients, there are some risks. As with any procedure, there may be complications associated and it's important to discuss all of the risks and benefits of minimally invasive lung resection surgery with your surgeon.

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Talking to your Doctor about Lung Resection Surgery

With any major procedure like lung surgery, you need to get all the information you can and make sure any questions you have about the procedure itself are answered completely. Your surgeon is the best person to provide those answers. Here are some questions about lung resection surgery for you to start the conversation:

• What are some of the benefits and risks associated with video assisted thoracic surgery (VATS)?
• Is VATS an appropriate procedure for me?
• How may VATS procedures have you performed?
• What should I do to prepare for surgery?
• What should I expect following thoracic surgery?
• How soon after the procedure will I be able to leave the hospital?
• How long will the recovery process take?
• When will I be able to get back to my normal activities?
• Will I have any long-term side effects?