Lung Cancer Surgery for Diagnosis and Treatment

Surgery can be used to diagnose and treat lung cancer.

Surgery for Small-Cell Lung Cancer

Because small-cell lung cancer has often spread beyond the lungs before it is detected, surgery is not typically the primary treatment recommended. It can be considered for patients with very early stage (Stage I) small cell lung cancer, if diagnostics show only one small tumor confined to the lung with no lymph node involvement. There must be no evidence that the cancer has spread on imaging tests, including PET-CT and brain MRI.

If surgery is used to treat small-cell lung cancer, it is typically followed by chemotherapy and potentially, radiation therapy, to decrease the chance of the cancer returning.

Surgery for Non-Small Cell Lung Cancer

For people with non-small cell lung cancer (NSCLC), surgery is the most effective treatment when it is likely that all of the cancer can be removed with surgery. Patients with early stage NSCLC (localized cancer that has not spread beyond the lungs or invaded vital organs) are good candidates for lung surgery. Tumors are classified with the designations T1, T2, T3 and sometimes, T4, which describe tumors according to size and location inside the chest. Lymph nodes are described as N0, N1, N2, or N3 depending on their location.

For more advanced stages of NSCLC, surgery may be combined with radiation and/or chemotherapy.

Patients must have lab tests, pulmonary function tests, and other tests to make sure they are strong enough to tolerate surgery. Pulmonary function tests are vital in determining how well the lungs are working and how well they will function if part of a lung or a whole lung is removed.

Surgery may involve removing the tumor, sections of the lung that contain the tumor and nearby lymph nodes. Surgery can be diagnostic or therapeutic, and sometimes, it is both at the same time. For example, thoracic surgeons may perform a wedge resection to remove an area of suspicious tissue, so it can be tested to see if it is cancer. In most cases, removing the tissue or tumor is also the best option for treating the cancer.

When surgeons remove the tissue, a pathologist examines it while the patient is still in the operating room. If the tissue is cancerous, surgeons can continue, removing as much of the lobe or lung where they found the cancer as it is possible do safely.

Surgery for Cancers That Have Spread to the Lungs

Surgery can also be considered for lung nodules caused by cancers that have metastasized (spread) to the lungs. This includes (but is not limited to) colorectal cancers, pancreatic cancer, head and neck cancers, and sarcomas. The surgery is called pulmonary metastasectomy. Surgically removing these cancers may be needed for diagnosis (to confirm metastasis) and/or treatment (to remove the cancer for a better chance of controlling it). In most cases, pulmonary metastasectomy involves a wedge resection but more lung tissue may be removed depending on the size and/or location of the tumor.

Robotic-Assisted Thoracoscopic Surgery (RATS)

Robotic-assisted thoracoscopic surgery is the preferred minimally invasive surgical approach. RATS typically results in less pain, faster recovery and fewer complications for the patient compared to open surgery. Robotic instruments are very sophisticated and have a range of motion similar to that of a human hand. Optics, magnification and the ability to see what is being operated on are also enhanced with robotics.

For cancers that are detected early, RATS is as effective in treating the cancer as more invasive surgical options. However, some patients may still need to have a thoracotomy (an open surgical procedure) or a surgery that combines minimally invasive and open techniques. That decision is usually made based on the patient’s surgical history, anatomy and the location of the tumor.

If a mass or nodule is very small or not very solid, your surgeon may inject a small amount of dye into the tumor using bronchoscopic guidance. Using a special camera in the operating room, a surgeon can locate the dye marker to more easily find the tumor and remove it. This technique can shorten the procedure and increase the certainty of a successful biopsy.

Surgical procedures that can be performed with RATS include:

• Wedge resection: removal of a triangle-shaped section of a lung, including the suspicious area or mass and some normal tissue around it. A wedge resection is most effective for a single nodule located in one spot.
• Segmental resection: removal of a section of the lung with the tumor and normal tissue around it. This is effective for small, peripheral tumors and may be the procedure of choice for patients with compromised lung function.
• Lobectomy: removal of an entire lobe of the lung. A lobectomy is most effective for cancers located in just one lobe. Lobectomy is currently the gold standard therapy for lung cancer in patients who can tolerate it.
• Pleurodesis: Draining fluid outside the lung, while slowly infusing a chemical to prevent future fluid buildup.
• Pneumonectomy: This is the removal of the entire lung. This procedure may be done using the traditional, open method or a combination of the open and RATS procedures. We are one of the few centers in the area that offers this procedure.