Lung Cancer: Surgery

Memorial Sloan Kettering 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, and 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.

Removing Cancer, Preserving Quality of Life

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 are frequently 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). At Memorial Sloan Kettering our surgeons offer lung-sparing surgery to remove the cancer and preserve remaining lung tissue whenever possible.

Surgery for Non-Small Cell Lung Cancer

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. People with early-stage non-small cell lung cancer who are not candidates for surgery are typically treated with stereotactic body radiation therapy (SBRT), treatment that offers excellent long-term chances to eradicate small lung lesions.

Patients with advanced non-small cell lung cancer that has spread to the lymph nodes but is still confined to the chest and who cannot be treated surgically either because of a tumor’s location or because of the patient’s health can also benefit from radiation therapy. It is ideally given with chemotherapy administered either at the same time or before or after radiation therapy.

Surgery for Small Cell Lung Cancer

Surgery is rarely part of the treatment for small cell lung cancer because the disease tends to spread quickly and responds well to chemotherapy and radiation therapy. In certain cases, however, particularly if the cancer is identified at an early stage, surgery to remove small cell tumors can be an option. Memorial Sloan Kettering surgeons are skilled in removing small tumors, including those that are located near the exterior of the lung and those that have not spread beyond the lung.

Patients who are able to have surgery for small cell lung cancer typically receive adjuvant chemotherapy (chemotherapy given after surgery). This approach has been shown to improve cure rates when compared with surgery alone.

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.

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. Fortunately, at Memorial Sloan Kettering our surgeons rarely need to perform a pneumonectomy to remove the lung cancer.

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 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.

Memorial Sloan Kettering surgeons are highly experienced in using minimally invasive procedures, including video-assisted thoracic surgery (VATS) – also called thoracoscopy – and robotic surgery.

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. Our thoracic 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
  • fewer complications, particularly in older patients

While VATS is used only 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.

Robotic Surgery

Our thoracic surgeons 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.

Robot-assisted surgery is another minimal-access approach that allows surgeons to perform operations using scopes and instruments inserted through several small incisions. The robot adds enhanced vision and control and consists of several components, including four interactive robotic arms and a three-dimensional, high-definition vision system.

Robot-assisted surgery results in smaller incisions that offer the potential for less postoperative pain, less blood loss, a shorter hospital stay, and quicker recovery. In principle, the operation may be more effective and the side effects may be reduced. However, benefits and side effects may vary with each procedure. In fact, studies confirm that the results of any type of surgery depend more on the skill and experience of the surgeon than on the technology used.