Lung Cancer Surgery

There are several types of lung cancer surgery used in the treatment of cancers of the lung. As with many cancers, surgery is often part of the lung cancer treatment regimen, either alone or along with other treatments such as chemotherapy and/or radiation.

There are a variety of surgical approaches and procedures used for lung cancer, some of which are minimally-invasive and best suited for diagnosis and smaller biopsies and some of which are aimed at definitive treatment of the cancer. Below, we present several of the types of surgery offered for diagnosis and/or treatment of lung cancer.

Below are some of the common lung cancer surgery approaches used. The specific procedure used depends on many factors including the size and location of the tumor and the goal of surgery (diagnosis, treatment, palliation, etc.).

Types of Lung Cancer Surgery:

Thoracoscopy: Another lung cancer surgery that uses a small incision to introdue a scope into the chest. However, here the scope is passed into the side of the chest cavity around the lungs to directly inspect the surface of the lungs where some cancers can occur. This can aid in diagnosis and treatment, particularly in being able to take small biopsies of the tissue to send to a pathologist to determine the type of cancer. Sometimes called video-assisted thoracic surgery (VATS).

Bronchoscopy: Although not technically a surgical procedure, bronchoscopy is one of the minimally-invasive approaches to the lungs that are used in both lung cancer diagnosis and treatment. A bronchoscope is a small, flexible scope that allows doctors to look into the larger airways of the lungs (trachea and bronchii). They can take small samples of tissue through the scope, such as washings, brushings or small biopsies, to aid in the diagnosis and further work-up of the cancer. In addition, some treatments, such as photodynamic therapy, are performed through the bronchoscope. In general, use of the bronchoscope for treatment is only possible when the tumor involves the airways of the lungs. Tumors far removed from the larger airways cannot be seen or closely approached with the bronchoscope.

Wedge Resection: This is a term for an open surgical procedure to remove a small section of one lung that contains tumor.

Segmentectomy: Each lung is divided into lobes and then each lobe is divided into segments. This is a lung cancer surgery that removes one segment of the lung that contains cancer.

Lobectomy: A bigger removal than either the wedge resection or segmentectomy, a lobectomy removes an entire lobe of one lung. This is a very common procedure for initial removal of lung cancer. Of note, the left lung is divided into two lobes and the right lung is divided into three.

Sleeve Resection: A sleeve resection is a type of surgery sometimes used for tumors which originate from one of the larger airways in the lungs. Part of the airway is removed, sometimes with or sometimes without some surrounding lung tissue. The remaining ends of the airway are then reattached to preserve lung tissue and avoid the larger types of removals which would sacrifice a whole lobe or lung.

Pneumonectomy: A pneumonectomy is the complete removal of one whole lung. This is sometimes recommended for large, more invasive tumors which cannot be removed by a more limited surgical removal of part of the lung. Assuming the other lung is healthy, patients can live and breath normally with only one lung remaining.

Types of Approaches to the Chest Cavity
Commonly, lung cancer surgery involves opening the chest cavity surrounding the lung to give the surgeon direct access to the lung. One of the most common approaches to accomplish this is called a thoracotomy. In a thoracotomy, a long, curving incision is made on the side of the chest between two ribs. The ribs can then be pulled apart to expose the chest cavity and lungs beneath.

Alternatively, a sternotomy is an opening of the middle of the chest through the breast bone. This is a good approach to expose the middle part of the chest, including the major airways of the lungs and the heart. While it is used most frequently for heart surgeries, it can sometimes be used in some cases of lung cancer.

Other more limited openings are sometimes used through the front, side or back of the chest (such as the posterolateral thoracotomy or anterolateral thoracotomy) to access particular parts of the lungs. While these smaller openings do not expose as much of the lung, they may be adequate for more limited resections of a small tumor in part of the lung, such as a small wedge resection (see above).