Lung Cancer Surgery

Lung Cancer Surgery at Virginia Mason Hospital & Seattle Medical Center

When lung cancer is found at a favorable or early stage in which the cancer is still limited to the lung, surgery has been identified as the best treatment approach for providing the potential to cure the cancer. Unfortunately, less than half of all lung cancers are found at this stage; however, in some instances, patients may have chemotherapy and/or radiation therapy first to shrink the tumor before a final decision is made about surgery.

The lung cancers most commonly considered for surgery are those that remain within the lung tissue or involve lymph nodes which are within the lung itself. Special consideration for surgery can also include cancers that directly invade structures outside of the lung, including the chest wall and diaphragm, or cancers that have spread to the lymph glands in the mediastinum, which is the area between the lungs.

Standard lung cancer surgery involves removing the portion of the lung that contains the cancer. This may include:

  • Video-assisted thoracic surgery (VATS) -  The VATS technique allows the surgeon to operate on the lungs through small incisions using a small video camera.
     
  • Lobectomy and segmentectomy - Lobectomy, or the removal of one lobe of lung tissue, remains our gold standard for treating early-stage lung cancer. Segmentectomy involves removing the smallest anatomic piece of lung tissue (less than an entire lobe) to provide a safe treatment option for patients who would otherwise not be surgery candidates.
     
  • Sleeve resection/lobectomy - This highly specialized procedure allows the removal of part of the airway with or without adjoining lung tissue, followed by reattachment of the healthy tissue.
     
  • Intraoperative brachytherapy - Our center was one of the first in the region to introduce intraoperative brachytherapy, a treatment that places tiny cancer-killing radioactive "seeds" at the tumor site.

You may also qualify for one of several advanced surgical techniques in which the tumor only is targeted, sparing as much lung tissue as possible. These newer surgeries include cryotherapy and photodynamic therapy, and the more common laser therapy (see Endobronchial Therapy).

Surgery is not considered an option if the cancer has spread to the other lung, to lymph nodes in the neck, to other sites such as the liver or bones, or if the state of your general health makes the surgery too great a risk.

During your operation, called an open thoracotomy, your surgeon will make an incision along the back and side of the chest wall of the affected lung. Sometimes a portion of a rib is removed to facilitate spreading the ribs during the operation.

Your anesthesiologist will put a special breathing tube in place that allows him or her to separate the breathing of the two lungs during the operation.

Your surgeon will divide the major arteries, veins and airways to the part of the lung being removed. At the completion of the operation, chest drains are inserted between the ribs to drain fluid and air for several days following the surgery, and to ensure that the residual parts of the lung remain fully functional. The drains are removed one to five days later.

Your operation may take between two and three hours; however, it can be longer in some patients. Following removal of one lobe or lung, hospital stays average four to seven days. When smaller areas of lung are removed, hospital stays average two to four days.