Lung cancer surgery: Types, recovery and survivorship

By Jessica Saenz

Lung cancer continues to be the leading cause of cancer death worldwide, but death rates and new cases have decreased. More people in the U.S. are surviving lung cancer than ever before, and with improved treatments, patients now have more options, including different types of surgery.

Shanda Blackmon, M.D., a Mayo Clinic thoracic surgeon, shares what she tells patients about lung cancer surgery, recovery and survivorship:

Types of lung cancer surgery

Surgery may be an option if your cancer is confined to your lungs and you have good lung function. "If you and your health care professional decide surgery is an option, several approaches can be taken depending on your tumor's location," says Dr. Blackmon. "My patients with advanced lung cancer are often surprised to learn that they can have an entire lung removed," she says.

Surgical procedures to remove lung cancer include:

• Wedge resection to remove a small lung section containing the tumor and a margin of healthy tissue.
• Segmental resection to remove a larger portion of lung, but not an entire lobe.
• Lobectomy to remove the entire lobe of one lung.
• Pneumonectomy to remove an entire lung.

Dr. Blackmon says open lung cancer surgery, which requires an incision between the ribs to access the lungs, is often necessary. Minimally invasive surgery uses various techniques to operate with less damage to the body than with open surgery. "If minimally invasive surgery is possible, it offers options that give people a lot of lung function to work with later on," she says.

Minimally invasive lung cancer surgery options include:

• Thoracoscopic surgery uses small incisions to insert a camera and small surgical tools into the chest.
• Robotic surgery requires four or five tiny incisions for robotic arms controlled by your surgeon.
• Ablation uses a small probe with heat or cooling mechanisms to destroy tumor tissue.

Questions to ask your care team before lung cancer surgery

Dr. Blackmon says it's critical to ask your cancer care team and lung cancer surgeon questions, and if you don't understand something, ask for clarification. Before deciding on treatment, she recommends asking:

• What stage is my lung cancer? "The treatment decisions made before and after surgery are directly related to your cancer stage. Too often, I see people who had a procedure done that wasn't appropriate for their cancer stage. Before making treatment decisions, make sure your treating physicians know your cancer stage.”
• Can I record this on video/take notes/call someone during my visit? "Frequently, patients are overwhelmed with their diagnosis and can't remember what was said during their appointment. I recommend patients record visits.”
• What are my treatment alternatives? "Sometimes, people are told they're having a lobectomy, but if their lung function isn't good, that might not be the best option. Patients need to know there are alternatives, such as removing part of a lung (a wedge or segmental resection), radiation or ablation."
• How is my lung function? "We always test patients' pulmonary function. We consider other options if we predict a patient may have poor lung function after surgery."
• Do you offer minimally invasive options? "Not every lung cancer surgery can be minimally invasive, but if it can, there are benefits. Those long-term benefits sometimes extend into survivorship."
• What will my pain be like after surgery? "We don't want patients to expect to be completely pain-free. That expectation puts them at higher risk for opioid addiction. Taking so many narcotics that they aren't feeling pain means they're probably not taking deep breaths. We try to find the right balance to control pain and help them recover faster."
• Is genetic testing right for me? "Patients with certain mutations might be candidates for targeted therapy or other treatment options."
• Is a clinical trial right for me? "There are many opportunities for enrolling in clinical trials that offer the standard of care, plus something potentially better."
• Do you specialize in lung cancer surgery? "It comes down to the ability of the institution to rescue you if something goes wrong and to deal with complications or to prevent them. Sometimes, staying close to home isn't best if another institution does lung cancer surgery in high volumes." Research has shown cancer centers that perform a high volume of lung cancer surgeries provide better patient outcomes.

Recovery from lung cancer surgery

The length of your hospital stay and recovery depends on the type of surgery you have. "If you had a small part of your lung removed, you might be able to stay overnight in the hospital and go home the next day," says Dr. Blackmon. "However, if you have an entire lung removed, you may need to stay in the hospital for a week or two. If you have a complication, you might need to stay longer."

You may also experience short-term or long-term side effects from surgery. Dr. Blackmon says incision pain, pain when breathing, pneumonia, blood clots, blood loss, infection and air leaks are the most serious short-term risks post-surgery.

Long term, Dr. Blackmon says the most significant risks and effects are pain and reduced lung function. "We're always looking at ways to prevent long-term pain. That's why I'm a big proponent of minimally invasive surgery," she says. "If you have an open lung cancer surgery and your rib is cut, and the chest is open, you're at higher risk for chronic pain. If the nerves are damaged, it could damage the function of your diaphragm, which could give you long-term breathing effects."

Survivorship after lung cancer surgery

Survivorship can be a challenging journey for everyone, and that doesn't end after you recover from surgery. "Far too often, I see patients who have gone through surgery, and they're recovering, but they still have moments when they feel very alone," says Dr. Blackmon.

Survivorship's emotional and physical aspects can play a role in your recovery, so it's important to address them with your care team. Ask about support groups, survivorship programs, rehabilitation and surveillance. "That five-year period after lung cancer surgery is critically important. In that period, there is about a 2% to 2.5% chance that patients might develop a new cancer, so they need surveillance," says Dr. Blackmon. Work with your care team to create a plan for follow-up care and achieving your best quality of life in survivorship.

Learn more

Watch Dr. Blackmon discuss lung cancer surgery and survivorship in this "Mayo Clinic Q&A" podcast video.

Learn more about lung cancer and find a lung cancer clinical trial at Mayo Clinic.

Join the Lung Cancer Support Group on Mayo Clinic Connect.

Also read:

• "Era of hope for patients with lung cancer."
• "Emotional recovery after cancer treatment."
• "Surviving cancer: What to expect after the diagnosis."