Surgery for Lung Cancer
Overview
A thoracic (thor-A-sik) surgeon is a doctor with special training in surgery for the chest, lungs, airways, esophagus (swallowing tube), and thymus. They’re also known as a chest surgeon. Their goal is to remove the tumor or nodule (NAH-jool). A nodule is a growth or lump that may be cancer or benign (not cancer).
Surgery is the best option for some people with lung cancer. Your surgeon will talk with you about which surgery is best for you, based on the:
- Type of lung cancer
- Stage
- Location of the tumor or nodule
- Tumor’s characteristics, including its genetic information
Many surgeries for lung cancer at MSK use methods that are less invasive. This is called minimally invasive surgery because it does less harm to nearby tissue.
This method uses small incisions (cuts) and special instruments. Minimally invasive surgery for lung cancer done at MSK can help speed recovery, with fewer complications (problems).
Why surgery is used to remove lung tumors
The goal of surgery for lung cancer is to remove areas of your lung that have cancer. Your surgeon also may remove nearby lymph nodes. This helps make sure we get all of the cancer cells.
Lung nodules are common problems. A nodule resection just means surgery to remove a nodule. It’s done using the same surgeries for lung cancer.
The type of surgery you have depends on the size of the tumor. It also depends on where the cancer has spread within the lungs.
Lung anatomy: Your lungs are made up of lobes. Your left lung has 2 lobes, and your right lung has 3 lobes.
- Sublobar operations include surgery to remove parts of the lung within 1 lobe.
- A wedge is when we remove a small part of a lobe.
- A segmentectomy (seg-men-TEK-toh-mee) is when we remove a slightly bigger part of a lobe.
- A lobectomy (loh-BEK-toh-mee) is when we remove a whole lobe. A lobectomy is the most common surgery for non-small cell lung cancer.
- A bilobectomy (bill-oh-BEK-toh-mee) is when we remove 2 lobes of the right lung. It involves the upper and middle lobes, or the middle and lower lobes.
- A pneumonectomy (NOO-moh-NEK-toh-mee) is when we remove 1 whole lung. It’s done when the cancer is in the center of the lung and cannot be removed with other types of surgery. A pneumonectomy is only for people who have an opposite lung that works well, so they’ll have enough oxygen.
Read “Types of surgery for lung cancer” below for more information.
When do we recommend surgery for lung cancer?
Non-small cell lung cancer (NSCLC)
Surgery is a treatment for non-small cell lung cancer. Most people have NSCLC only in 1 lung. The best chance for a cure is surgery to remove all the tumor and check nearby lymph nodes.
At MSK, our thoracic surgeons can often remove the tumor while taking out only a small part of the lung. This is called a segmentectomy or wedge resection. This procedure helps keep more of your lung working. Sometimes, we must remove a larger part of the lung, called a lobe. This is called a lobectomy. In very rare cases, we may remove the whole lung.
Surgery may not be right for people with early-stage NSCLC and other bad health problems. Instead, we may recommend stereotactic body radiation therapy. This treatment can remove small tumors without surgery.
Surgery is not the first option for advanced NSCLC that's in lymph nodes but still only in the chest. Treatment may start with immunotherapy or targeted therapy. You may have surgery after, based on how you respond to treatment. Your MSK care team will choose a treatment plan that’s best for you.
Sometimes, surgery is not possible because of the tumor's location or your general health. Instead, we may recommend radiation therapy, often along with chemotherapy or immunotherapy.
Lung cancer is called metastatic when it has spread elsewhere in the body. Surgery can be an option for lung cancer that only has spread to very few other places. This type of metastasis is called oligometastatic (AH-lih-goh-meh-TAS-tuh-tik) cancer. People with oligometastatic cancer most often already had immunotherapy or other treatments.
If surgery is not right for you, our radiation oncologists have ways to treat these tumors with targeted radiation.
MSK thoracic surgeons were among the first to do lung cancer surgery after targeted therapy. It’s an option for people who have tumors with certain gene changes, such as EGFR and ALK. In 2024, we published a large study of how well surgery worked for people after another treatment.
When is surgery for lung cancer not recommended?
Small cell lung cancer
Small cell lung cancer rarely is treated with surgery. It can spread fast and responds well to chemotherapy and radiation therapy.
Sometimes surgery can remove small cell tumors, most often if the cancer is found early. MSK surgeons are skilled in removing these small tumors. This includes small tumors:
- Near the outside of the lung.
- That have not spread outside the lung.
People who can have surgery for small cell lung cancer most often also have adjuvant (A-joo-vunt) therapy. This is chemotherapy you get after lung cancer surgery. It’s used to kill any cancer cells that may be left in your lung or the rest of your body. Chemotherapy along with surgery works better than having surgery only.
Advanced non-small cell lung cancer
Surgery may not be the best option for a few reasons, including:
- The cancer has spread to many lymph nodes in the chest.
- There is fluid around the lung that has cancer cells.
- The lung cancer has spread to important organs in the chest.
- The tumor’s location and your general health make surgery harder to do.
About 3 out of every 4 people who have lung tumors removed at MSK have minimally invasive surgery. Each year we do more than 440 minimally invasive surgeries, including video-assisted thoracic surgery (VATS) and robot-assisted surgery. We’re one of the busiest centers for such surgeries worldwide.
Types of surgery for lung cancer
There are many types of lung surgeries to remove lung tumors and nodules. Your surgeon will talk with you about which type you’ll have. We explain some surgeries in this section.
A wedge is surgery to remove a small part of a lobe
A wedge is when a small part of a lobe of the lung is removed.
A segmentectomy is surgery to remove a slightly bigger part of a lobe.
A segmentectomy is when a bit bigger part of a lobe is removed.
A lobectomy is surgery to remove the tumor and an entire lobe of the lung
A lobectomy is when a whole lobe of the lung is removed.
A pneumonectomy is surgery to remove 1 whole lung
A pneumonectomy is when 1 whole lung is removed.
An open thoracotomy is when your surgeon makes a big incision (cut) and spreads the ribs apart to reach the lung.
Thoracotomy incision for lung cancer surgery.
MSK thoracic (chest) surgeons do more than 2,500 operations and 6,000 procedures each year. They’re national and world leaders in treating unusual tumors and complex cancer cases. We’re experts in high-risk lung surgeries and tumors that are hard to remove.
Minimally invasive lung cancer surgery
MSK surgeons are experts in surgery methods that do less harm to your body. When we can, we recommend minimally invasive lung cancer surgery. This method does less harm to your body because it’s done with small incisions (cuts).
We use minimally invasive surgery methods for most lung cancer operations. At MSK, that includes more than 3 out of 4 lung cancer resections. A resection is when we remove a tumor or nodule.
Benefits of minimally invasive surgery for lung cancer include:
- Less loss of blood.
- A shorter hospital stay.
- A faster recovery.
- Less scarring.
- Less risk of infection.
- Fewer complications (problems) during and after surgery.
- Less risk than regular surgery for people with other health conditions.
MSK does more than 440 minimally invasive surgeries each year. We're one of the busiest cancer centers for these procedures. Minimally invasive surgery methods include:
- Thoracoscopy (THOR-uh-KOS-koh-pee), also called video-assisted thoracic surgery, or VATS.
- Robot-assisted surgery.
MSK surgeons helped develop these minimally invasive methods.
What is video-assisted thoracic surgery (VATS)?
Video-assisted thoracic surgery (VATS): This procedure is also called thoracoscopy. Your surgeon makes 1 or more small incisions on your side, back, or both.
They’ll use a long, thin video camera and surgical tools. These special tools let them operate without spreading or breaking ribs.
Your surgeon may use a robot to control the video camera and surgical tools. This is called robotically-assisted VATS.
Your surgeon sits at a console and controls a robot that moves the surgical tools. The console has a special monitor where they can see the images from inside your chest in 3D.
3 VATS incisions for lung cancer surgery.
- Wedge: We remove a small part of a lobe.
- Segmentectomy: We remove a larger part of a lobe.
- Lobectomy: We remove a whole lobe.
- Bilobectomy: We remove the tumor and 2 lobes of the right lung.
What is robotic surgery (robot-assisted surgery)?
Robotic-assisted surgery for lung cancer is a type of video-assisted thoracic surgery, or VATS. It offers the same benefits as minimally invasive VATS.
With robotic-assisted surgery, your surgeon uses the da Vinci® Surgical System. They sit at a console and control a robot that moves the surgical tools. There are hand, finger, and foot controls.
The console has a special monitor where they can see very clear 3D images from a special flexible tool inside your chest. Your surgeon can see and remove a tumor. MSK’s operating rooms have the latest technology, including 11 robotic platforms.
MSK surgeons were among the first to use robotic-assisted VATS for lung surgery. We developed the method for this procedure and today it’s used around the world. MSK is among the busiest cancer centers for robotic chest surgery.
- Segmentectomy: We remove a larger part of a lobe.
- Lobectomy: We remove a whole lobe.
- Bilobectomy: We remove the tumor and 2 lobes of the right lung.
- Sleeve resection: This is a complex surgery to remove cancer while saving the healthy part of the lung. We remove the tumor and 1 lobe. We rebuild the bronchus. This is the breathing tube that connects the windpipe to the lung.
Common questions
In general, surgery for lung cancer lasts between an hour and a half to as long as 6 hours.
On average, surgery takes about 2 to 3 hours.
How long a surgery lasts depends on how complex your procedure is. It also depends on the method. A minimally invasive surgery takes less time than open surgery.
The number of days you’ll be in the hospital depends on a few things.
They include your general health, and how complex your surgery was. How long you’re in the hospital also depends on if you have any complications (problems) after surgery.
If you had open surgery, the average hospital stay is 4 to 5 days.
If you had minimally invasive procedures (VATS or robotic-assisted surgery), the average hospital stay is 2 to 3 days.
Not everyone feels pain the same way. They also do not have pain or discomfort for the same amount of time. In the first days after surgery, you may still have some pain when you go home. Most often, you’ll be taking pain medicine.
After the first week, the pain often gets much better. Most people can stop taking medicine in 3 to 4 weeks.
Some people can have soreness, tightness, or muscle aches around their incision for up to 6 months. This does not mean something is wrong. You’ll have less pain and need less pain medicine as your incision heals.
In the hospital, it’s important to do coughing and deep breathing exercises to help your lungs expand fully. This helps prevent pneumonia.
You’ll have a tool called an incentive spirometer (in-SEN-tiv spy-rah-MEE-ter) to help clear your lungs. Read How To Use Your Incentive Spirometer to learn more. Our respiratory therapists will provide treatments to help you breathe better.
At home, it’s important to keep active with regular walking and deep breathing. You may have more shortness of breath than you did before surgery. It will get better once the pain and inflammation (swelling) from the surgery starts to go away.
You’ll fully recover in a few weeks to a few months.
How long it takes to return to your normal life depends on a few things. They include your age and your general health. Recovery time also depends on the type of lung cancer surgery, and how much lung was removed.
If you had VATS, you may be able to do your normal activities in 2 weeks. If you did not have minimally invasive surgery, it may take up to 4 to 6 weeks.
You’ll meet with your doctor 2 to 3 weeks after the surgery. They’ll give you instructions about which activities you can do, such as exercise, sports, or lifting more than 10 pounds.
