This guide will help you prepare for your thoracic surgery or procedure at Memorial Sloan Kettering Cancer Center (MSKCC). The word “thoracic” refers to your thorax, or your chest area. This includes your heart and lungs. You have 2 lungs, 1 on each side. The lungs are made up of lobes. Your left lung has 2 lobes and your right lung has 3 lobes. Two thin membranes called the pleura line and surround your lungs.
Thoracic surgery can be performed using either video-assisted thoracic surgery (VATS) incisions, robotically assisted VATS, or a thoracotomy incision. VATS is usually done through 1 or more small incisions. The thoracotomy surgery usually uses a single large incision. Your doctor will tell you which type of incision you will have. How long you stay in the hospital will depend on which type of surgery and which type of incision you will have. Your doctor will also discuss this with you before your surgery. There are many types of thoracic surgeries. Your doctor will explain which type you will be having. The differences between these surgeries depend on how much of the lung will be removed. Examples of some surgeries are described below.
At MSKCC, we want to keep you safe during your surgery. You can help by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications, including patches and creams.
- I take over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems after surgery. Please tell us if you have sleep apnea or if you think you may have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medications to help prevent them.
- If you use alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
People who smoke can have breathing problems and a higher risk of getting pneumonia when they have surgery. Quitting smoking is one of the most important things you can do to decrease your risk of complications after surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Cessation Program at (212) 610-0507. You can also ask your nurse about the program.
Within 30 days of your surgery
Presurgical testing (PST)
During your PST appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). You can eat and take your usual medications the day of your PST appointment. During this appointment, your nurse practitioner will review your medical and surgical history with you, including your medications. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers. It is very helpful if you bring the following with you to your PST appointment:
A list of all the medications you are taking, including patches and creams
Results of any tests done outside of MSKCC, such as a cardiac stress test, echocardiogram (ECG), or carotid doppler study
The name(s) and telephone number(s) of your doctor(s)
The PST clinic is located in the Rockefeller Outpatient Pavilion, also known as MSKCC 53rd Street.
Rockefeller Outpatient Pavilion
160 East 53rd Street (at Third Avenue)
New York, NY 10022
There are several options for parking during your PST appointment. The Bristol Garage offers discounts to patients. To receive the discount, have your parking ticket validated at the concierge desk in the Rockefeller Outpatient Pavilion. Shuttle service is provided from the Bristol Garage to the Rockefeller Outpatient Pavilion every 20 minutes.
The Bristol Garage
300 East 56th Street
(Between First and Second Avenues)
New York, NY 10022
There are additional parking garages located at:
East 53rd Street between Second and Third Avenues (2 garages available)
East 54th Street between Second and Third Avenues
Health care proxy
If you haven’t already completed a Health Care Proxy Form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. This person is known as your health care agent. If you are interested in completing a Health Care Proxy Form, talk with your nurse. If you have completed a Health Care Proxy Form or if you have any other advanced directive, bring it with you to your next appointment.
Breathing and coughing exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, please read How to Use Your Incentive Spirometer, which is located in the “Resources” section of this guide. If you have any questions, ask your nurse or respiratory therapist.
Do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a healthy diet
You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet talk to your doctor or nurse about meeting with a dietitian.
10 days before your surgery
If you take aspirin or medications that contain aspirin, talk with your surgeon. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), which is located in the “Medications” section of this guide.
Purchase Hibiclens® skin cleanser. Hibiclens® is available at your local pharmacy without a prescription.
7 days before your surgery
If you take a multivitamin, talk with your doctor or nurse about whether you should continue. Stop taking herbal remedies or supplements. For more information, please read Herbal Remedies and Cancer Treatment, which is located in the “Medications” section of this guide.
2 days before your surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), which is located in the “Medications” section of this guide.
1 day before your surgery
Presurgical phone call
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on Friday. If you do not receive a call by 7:00 pm, please call (212) 639-5014.
Use this area to write in information when the clerk calls:
Date: ______________ Time: ______________
MSKCC Presurgical Center (PSC)
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY
B elevator to 6th floor
Night before your surgery
Hibiclens® is a skin cleanser that kills germs for 6 hours after using it. It will help reduce your risk of infection after surgery. To shower using the Hibiclens® solution, open the bottle and pour some solution into your hand or a washcloth. Rub gently over your entire body from the neck down and rinse. Do not let the solution get into your eyes, ears, mouth, or genital area. Dry yourself off with a clean towel after your shower.
Go to bed early and get a full night’s sleep.
Do not eat or drink anything after midnight the night before your surgery. This includes water, hard candy, and gum.
Morning of your surgery
Shower using Hibiclens® from your neck down just before you leave for the hospital. Use the Hibiclens® the same way you did the night before. Do not use any other soap.
Your doctor or nurse practitioner may have told you to take certain medications the morning of your surgery. If so, list them below. Take only these medications with a small sip of water the morning of your surgery.
Do not eat or drink anything the morning of your surgery. This includes water, hard candy, and gum. Take any medication as instructed with a small sip of water.
Things to remember
- Do not put on any lotions, creams, deodorants, makeup, powders, or perfumes.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook at home.
- Before you are taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles (such as a rosary).
- Wear something comfortable and loose-fitting.
What to bring
Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accommodate this swelling.
A CD player and CDs or an iPod, if you choose. However, someone will need to hold these items for you when you go into surgery.
Your incentive spirometer, if you have one.
Your breathing machine for sleep apnea (such as your CPAP), if you have one.
If you usually wear contact lenses, wear your glasses instead. Remember to bring a case for them.
Your Health Care Proxy Form, if you have completed one.
When you arrive
Parking at MSKCC is available in the garage onEast 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a tunnel that connects the garage to the hospital. There are also other garages nearby: four on East 69th Street between First and Second Avenues, one on East 67th Street between York and First Avenues, and three on East 65th Street between First and Second Avenues. If you have questions about prices, call (212) 639-2338. Please note that parking costs are not included in your room charge.
What to expect
Tell us who you are
You will be asked to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having surgery on the same day.
Tell your nurse about medications you’ve taken
A nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Get dressed for your surgery
You will be given a hospital gown, robe, and nonskid socks.
Prepare for your surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery, which is located in the “Resources” section of this guide. You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs. Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.
Your anesthesiologist may also put an epidural catheter (thin, flexible tube) in your spine (back). This will be used to give you pain medication. The medication is delivered into your epidural space, which is the area just outside your spinal cord. It will give you pain relief with fewer side effects, such as nausea, vomiting, and sleepiness. This is similar to what is given to women when they have babies.
Once you are fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You will also have a urinary catheter placed to drain urine from your bladder. You will have a bronchoscopy at this time. You will then be turned onto your right or left side, depending on if your surgery is on your right or left lung.
The length of your surgery depends on which type of surgery and incision you have. Your doctor will discuss this with you before your surgery. Once your surgery is finished, your incisions will be closed with stitches that will absorb as you are healing. Steri-StripsTM (thin pieces of tape) will be placed directly on your incision(s) and covered with a bandage. Your breathing tube is usually taken out while you are still in the operating room.
When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU).
You will receive oxygen through a thin tube that rests below your nose called a nasal cannula. You will have 1 or 2 chest tubes attached to tubing that goes into a draining device. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You may have a urinary catheter (Foley®) in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation.
You will have a pain pump called a patient-controlled analgesia (PCA) device. For more information, please read Patient-Controlled Analgesia (PCA), which is located in the “Resources” section of this guide. You may receive pain medication through an epidural catheter or your intravenous line.
Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. Depending on the type of surgery you had, you may stay in the PACU overnight. After your stay in the PACU, you will be taken to your hospital room. There, your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.
- It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs and reduce your risk of developing pneumonia.
- Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, please read How to Use Your Incentive Spirometer, which is located in the “Resources” section of this guide.
- Continue to perform your breathing and coughing exercises every 1 to 2 hours while you are awake.
- Please see the lung pathway handout to see what to expect daily while you are in the hospital after your surgery.
Commonly Asked Questions: During Your Hospital Stay
The following section covers common questions patients ask after thoracic surgery. Speak with your doctor or nurse if you have any additional questions or if any of this information is unclear.
Will I have pain after my surgery?
You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often. You will be given medication to manage your pain as needed. If your pain is not relieved, please tell your doctor or nurse. It is important to control your pain so you can cough, breathe deeply, use your incentive
spirometer, and get out of bed and walk.
What is a chest tube?
A chest tube is a flexible tube that is used to drain blood, fluid, and air from around your lung after surgery. The tube enters your body between your ribs and goes into the space between the inner lining and the outer lining of your lung (see figure). This is called the pleural space.
When will my chest tube be removed?
Once your lung heals, your chest tube will be removed. The area will be covered with a bandage. Keep the bandage on for at least 2 days, unless your nurse gives you other instructions. You will most likely go home 1 or 2 days after your chest tube is removed.
Why is it important to walk?
Walking will help prevent blood clots in your legs. It also decreases your risk of having other complications such as pneumonia. Walking 1 mile, which is 14 laps around the unit while you’re still in the hospital, is a good goal.
Will I be able to eat?
The day you are moved to your hospital room, you will be on a clear liquid diet. The first day after your surgery, you may be advanced to a light breakfast and light foods during the day (a sandwich, yogurt, soup, and liquids).
Eating a balanced diet high in protein will help you heal after surgery. Your diet should include a healthy protein source at each meal, as well as fruits, vegetables, and whole grains. For more tips on increasing your calorie and protein intake, ask your nurse for the resource Eating Well During and After Your Cancer Treatment. If you have questions about your diet, ask to see a dietitian.
Commonly Asked Questions: After You Leave the Hospital
Will I have pain when I am home?
The length of time each patient has pain or discomfort varies. Some patients may have incisional soreness, tightness, or muscle aches for up to 6 months or longer. This does not mean that something is wrong. Follow the guidelines below.
- Call your doctor if the medication prescribed for you doesn’t relieve your pain.
- Do not drive or drink alcohol while you are taking prescription pain medication.
- As your incisions heal, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will relieve aches and discomfort.
- Pain medication should help you as you resume your normal activities. Take enough medication to do your exercises comfortably. Pain medication is most effective 30 to 45 minutes after taking it.
- Keep track of when you take your pain medication. It will not be as effective if you allow your pain to increase. Taking it when your pain first begins is more effective than waiting for the pain to get worse.
Can I shower?
You may shower 48 hours after your chest tube is removed. Taking a warm shower is relaxing and can help decrease muscle aches. Do not take tub baths until you discuss it with your doctor at the first appointment after your surgery.
Use soap when you shower and gently wash all of your incisions. Pat the areas dry with a towel after showering, and leave your incisions uncovered (unless there is drainage). Call your doctor if you see any redness or drainage from your incision.
How can I prevent constipation?
Your usual bowel pattern will change after surgery. You may have trouble passing stool (feces). This is a common side effect of pain medication. Please review the material your nurse gave you about fiber and constipation.
To avoid constipation, take a stool softener such as docusate sodium (Colace®) 3 times a day and 2 tablets of senna (a laxative) at bedtime. Continue taking the stool softener and laxative until you are no longer taking pain medication. Drink plenty of liquids. If you feel boated, avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower.
How can I help my lungs heal?
- Continue to exercise a minimum of 30 minutes per day. This will help you get stronger, feel better, and heal your lung. Make a daily walk part of your routine. Keep using your incentive spirometer and do your coughing and deep breathing exercises at home.
- Drink liquids to help keep your mucous thin and easy to cough up. Ask your doctor how much you should drink each day. For most patients, this will be at least 4 large glasses of water or other liquids (preferably juices) each day.
- Use a humidifier in your bedroom during the winter months. Follow the directions for cleaning the machine. Change the water often.
- Avoid sources of infection, such as contact with people with colds, sore throats, or the flu.
- Do not smoke. Smoking cigarettes is harmful to your health at any time. It is even more so at this time. Smoking causes the blood vessels in your lungs to become narrow. This decreases the amount of oxygen in the lungs. It can cause problems with breathing and regular activities. It is also important to avoid places that are smoky. Your nurse can also give you information to help you deal with other smokers or situations where smoke is present. Remember, if you need help quitting, MSKCC’s Tobacco Cessation Program can help.
- Do not drink alcohol, especially while you are taking pain medication.
How do I care for my incisions?
You will have more than 1 incision after your surgery. The location of your incisions will depend on the type of surgery you had. There will be incisions from the surgical site and the chest tube. You may have some numbness below and in front of your incisions. This is because your ribs were spread apart and some nerves were affected.
- By the time you are ready to leave the hospital, your surgical incision(s) will have begun to heal.
- You or your caregiver should look at your incision with your nurse before you leave the hospital so you know what it looks like.
- If any liquid is draining from your incision, you should write down the amount and color.
Chest tube incision
- You will have a bandage covering your chest tube incision.
- Keep the bandage on your incision for 2 days after your chest tube is removed, unless it gets wet. If it gets wet, change it as soon as possible.
- You may have some thin, yellow or pink-colored drainage from this area, which is normal. Place a Band-Aid® or dry piece of gauze over the area and change the bandage as needed.
Change your bandages at least once a day and more often if they become wet with drainage. When there is no longer any drainage coming from your incisions, they can be left uncovered.
If you go home with Steri-Strips on your incisions, they will loosen and fall off by themselves. If they haven’t fallen off within 10 days, you may remove them.
Is it normal to feel tired after surgery?
It is common to have less energy than usual after your surgery. Recovery time varies with each patient. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is a vital part of your recovery.
Can I resume my activities?
It is important for you to resume your activities after surgery. Spread them out over the course of the day. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. You can do light household tasks. Try dusting, washing dishes, preparing light meals, and other activities as you are able. You may return to your usual sexual activity as soon as your incisions are well healed and you can do so without pain or fatigue.
Your body is an excellent guide for telling you when you have done too much. When you increase your activity, monitor your body’s reaction. You may find that you have more energy in the morning or the afternoon. Plan your activities for times of the day when you have more energy.
When is it safe for me to drive?
You can begin driving again after you have:
- Regained full movement of the arm and shoulder on the side of your surgery
- Stopped taking pain medication
Can I travel by plane?
Do not travel by plane until you have discussed this with your doctor at your first appointment after your surgery.
When can I return to work?
The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals.
What exercises can I do?
Use the arm and shoulder on the side of your surgery in all of your activities. Use them when you bathe, brush your hair, and reach up to a cabinet shelf.
Slowly resume your normal activities to help restore full use of your arm and shoulder. The exercises shown below will help you to regain full arm and shoulder movement. You should begin these exercises as soon as your chest tube is removed.
- Sit in a straight-backed chair with your feet flat on the floor.
- Clasp your hands together.
- Lift your arms up and over your head.
- Slide your hands down to the back of your neck.
- Slowly twist the upper part of your body to the right side. Hold this position for 5 seconds while bringing your elbows as far back as possible.
- Return to the starting position.
- Slowly twist the upper part of your body to the left side. Hold this position for 5 seconds while bringing your elbows as far back as possible.
- Return to the starting position.
- Stand comfortably with your feet about 6 inches apart.
- Put your arms in front of your body and hold1 end of a hand towel in each hand.
- Bring your arms over your head, straighten your elbows, and stretch toward your upper back. Do not arch your back and do not force the movement if it is difficult. Try to hold the position for 5 seconds.
- Relax and return to the starting position.
- Stand as in Step 1.
- Grasp the towel behind your back and lift upward as far as possible. Be sure to stand straight. Try to hold the position for 5 seconds.
- Return to the starting position.
When can I lift heavy objects?
Check with your doctor before you do any heavy lifting. Normally, you should not lift anything heavier than 10 pounds for at least 3 weeks. Ask your doctor how long you should avoid heavy lifting. This depends on the type of surgery you had.
When can I resume heavy exercise?
Do not play sports until your doctor tells you it is safe. When you resume, remember that it will take time for you to return to your previous level of activity. Start out slowly and increase your activity as you feel better.
How can I cope with my feelings?
After surgery for a serious illness, you may have new and upsetting feelings. Many patients say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support.
The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It is always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you are in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.
When is my first appointment after my surgery?
Your first appointment after surgery will be in 1 to 3 weeks after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.
During this appointment, your doctor will discuss the pathology results with you in detail.
Call your doctor if you have:
New or worsening shortness of breath
A temperature of 101° F (38.3° C) or higher
Pain that does not get better with your medications
Redness, swelling, or drainage from your incisions that is foul smelling or pus-like
No bowel movement for 3 days or longer
Any new symptom or physical change
Any questions or concerns
After 5:00 pm, during the weekend, and on holidays, call (212) 639-2000. Ask to speak to the thoracic doctor on call.