Surgery for Lung Cancer: When Lung Surgery Is Recommended and What the Chances of Survival Are

Lung cancer is one of the most common types of cancer. If left untreated, it will eventually lead to death.

Strictly speaking, “lung cancer” is an umbrella term. The vast majority of patients actually have bronchial carcinomas. These tumors originate in the bronchi within the lung.

A further distinction within the group of lung carcinomas is crucial for treatment planning:

• small-cell (SCLC) bronchial carcinoma or
• non-small cell (NSCLC) bronchial carcinoma.

Surgical treatment for lung cancer is the treatment of choice, especially in the early stages (up to Stage IIIA) of non-small cell bronchial carcinoma. Unfortunately, in most patients, the cancer is already too advanced for lung cancer surgery.

Lung cancer often causes no symptoms in its early stages. As a result, most patients do not see a doctor until the cancer is already more advanced. At that point, lung cancer surgery is no longer performed; instead, the cancer is treated with chemotherapy and, if necessary, radiation therapy.

Small-cell lung cancers are operated on even less frequently: surgery is only considered in the very early stages. These cancers are particularly aggressive, grow very quickly, and metastasize early. However, these cancer cells are considered particularly sensitive and therefore respond well to chemotherapy and radiation therapy.

When planning treatment for lung cancer, in addition to the type of cancer and its stage,

• age and
• the patient’s health status

of the patient. Surgery is performed only if the lung is functioning properly and heart function is good. In some cases, additional radiation therapy or chemotherapy is recommended. Multimodal treatment approaches are becoming increasingly important.

Lung cancer surgeries are performed by specialists in thoracic surgery.

Lung cancer surgery is performed under general anesthesia and can last up to several hours, depending on the extent of the procedure. To remove the entire tumor along with a margin of healthy tissue and the regional lymph nodes, the chest (thorax) is usually surgically opened (thoracotomy).

In recent years, lung lobes have also been removed using minimally invasive techniques in early stages of cancer. This method is called video-assisted thoracoscopic lobectomy (VATS lobectomy).

Despite careful diagnostic testing, the exact amount of tissue that needs to be removed can often only be determined during the lung cancer surgery. The removed tissue undergoes an intraoperative pathological examination. Even terminating the surgery is a possibility, as the surgical procedure may turn out to be inappropriate.

Nowadays, a lobectomy—the removal of one or two lung lobes—is the most common procedure. If two lung lobes are removed, this is also referred to as a bilobectomy.

A lobectomy is generally considered sufficient in the early stages. It is technically less complicated and associated with a lower mortality rate than a pneumonectomy (removal of an entire lung). This procedure is necessary for large and/or centrally located tumors or when multiple foci are present. Pneumonectomy may also be performed if a tumor cannot be completely removed by lobectomy.

For very small and peripherally located carcinomas, sometimes only parts of a lobe are removed (wedge resection, segment resection). These procedures are less invasive for the patient. They are therefore also suitable for patients with poor lung function or poor general health.

After open lung cancer surgery involving a thoracotomy (opening of the chest), intensive care monitoring is required for several hours or even days. In total, the patient remains in the hospital for at least two to three weeks for treatment. Consistent pain management must be provided.

Any removal of lung tissue reduces the surface area available for breathing. However, an otherwise healthy lung can compensate for this, at least to a large extent, within weeks or months.

Particularly after a pneumonectomy, however, the patient’s physical performance is often significantly reduced for months following surgery.