If you have non-small cell lung cancer that has not spread beyond one lung, surgery to remove the tumor in its entirety provides the best chance for a cure.
Memorial Sloan-Kettering Cancer Center is among the most experienced centers in the United States in surgery for lung cancer:
- Our surgeons perform more than 1,200 operations for lung cancer each year.
- We have among the lowest rates of complications following surgery in the country.
- We use the most advanced surgical approaches, including video-assisted thoracic surgery (VATS), a minimally invasive technique that leads to faster recovery after surgery than traditional open surgical approaches.
The goal of surgery is to completely remove the cancer. At the same time, our highest priority is to do so in a way that ensures your safety, and that will allow you to have a good quality of life after the procedure.
Successful surgery requires removing the portion of the lung containing the cancer and the adjacent lymph glands (also called lymph nodes). Lymph glands in the chest trap cancer cells as they leave the lungs, and so are usually the first site to which lung cancer spreads.
How much lung is removed depends on many factors, including the size and location of the tumor, whether the cancer has been found in the surrounding lymph nodes, and your overall health and strength (particularly with respect to lung and heart function).
Types of Surgery
Three surgical procedures are commonly used to treat lung cancer. Which operation is performed depends on how large the tumor is, and where it has spread within the lungs.
Sublobar operations include surgery to remove parts of the lung within one of the lobes. This approach may involve removing a small section of the lung (called wedge resection), or removing one or more anatomic sections within a lobe (called segmentectomy). These operations are performed either when the tumor is very small (2 centimeters or less at its widest point) or when a larger lung removal would be too physically stressful for the patient.
Lobectomy and Bilobectomy
A lobectomy is the removal of a complete lobe of the lung. (There are three lobes in the right lung and two in the left lung). This is the most common operation performed for non-small cell lung cancer and is the best treatment for an isolated lung cancer in an otherwise healthy patient. A bilobectomy involves the removal of two lobes of the right lung (the upper and middle lobes, or the middle and lower lobes).
A pneumonectomy is the removal of an entire lung. It is performed when the cancer is located in the center of the lung and cannot be removed using a more localized operation. A pneumonectomy is only performed in patients who have good lung function and could recover and live without the need for supplemental oxygen.
Minimally Invasive Surgery
Traditionally, whatever the amount of lung removed, chest surgery was performed through a procedure called a thoracotomy, which involves making a large incision in the chest. Today, many lung cancer operations can be performed using minimally invasive approaches. Minimally invasive surgery includes a set of techniques that limits the amount of tissue that is damaged during an operation.
Although this approach is not appropriate for all patients, Memorial Sloan-Kettering surgeons increasingly use minimally invasive techniques to perform entire lung cancer operations without making large incisions or damaging the ribs. This results in faster recovery and makes it possible for patients who need further treatment, such as chemotherapy or radiation therapy, to begin it more quickly.
Our thoracic surgeons are experts in a technique called video-assisted thoracic surgery (VATS), or thoracoscopy. With VATS, only a few small incisions are necessary. The doctor then inserts a small device consisting of a camera, a light, and other instruments, and is able to operate on the lung and chest without spreading or breaking the ribs. Memorial Sloan-Kettering surgeons use the VATS approach for wedge resections, segmentectomy, lobectomy, and bilobectomy.
Surgeons at Memorial Sloan-Kettering have documented the benefits of VATS in comparison to traditional open thoracotomy. These include:
- a reduction in the time that chest tube drainage is needed
- shorter hospitalization
- less pain
- decreased complications, particularly in older patients
While VATS is only used in 30 percent of eligible cases in the United States, nearly 60 percent of patients at Memorial Sloan-Kettering are able to have this minimally invasive approach.
Members of our Thoracic Surgery Service were also involved in the development of robot-assisted VATS lung removal for lung cancer. This procedure combines high-definition, three-dimensional imaging with precise robotic instrumentation to further enhance the capability of the VATS approach.(1)