Surgery for lung cancer
The aim of surgery is to remove the part of your lung containing cancer and any nearby lymph nodes.
- Wedge resection or segment resection (segmentectomy): A small section of a lobe of your lung is removed. A segment resection removes slightly more of the lung than a wedge resection.
- Lobectomy: This is when a lobe of your lung is removed. Removal of 2 lobes is called bi-lobectomy. (Picture courtesy of CRUK / Wikimedia Commons)
- Pneumonectomy: Here an entire lung is removed. (Picture courtesy of CRUK / Wikimedia Commons)
During surgery, your surgeon will usually remove lymph nodes near the tumour and check them for cancer. Knowing if the cancer has spread to the lymph nodes helps your doctors decide if you need any other treatment.
You will have an assessment at a pre-admission clinic (PAC). You will have tests like a heart test (ECG or ECHO), lung tests (PFT and CPET), and blood tests. Before your surgery you should meet your surgeon, anaesthetist and nurse specialist. They will discuss your surgery with you and you will have to sign a consent form. It is important to discuss with them if you do not understand anything or you have any questions or concerns. Read some general advice about getting ready for surgery.
There are two main ways of doing surgery for lung cancer:
- Keyhole surgery means the cancer is removed through 2-4 small cuts between the ribs, guided by a tiny camera. People often recover more quickly from keyhole surgery than from open surgery and the scars are smaller. Video-assisted and robotic-assisted thoracoscopic surgery (VATS and RATS) are types of keyhole surgery used for lung cancer. They are not suitable for every patient.
- Open surgery means that the surgeon will make a cut (incision) in your chest to open it up by spreading the ribs so that he or she can do the operation to remove the cancer. You will have a larger scar afterwards.
Testing lymph nodes
Lymph nodes near the cancer will be removed during surgery. They will be checked for cancer cells. Knowing if the cancer has spread to the lymph nodes also helps your doctors decide if you need any other treatment.
Depending on the type of surgery you have had, you may be in an intensive care unit (ICU) or high dependency unit (HDU) for a few days after surgery.
You will have a few drips and drains in place - such as a chest drain, a drip with fluids and a catheter. It is normal to have these in place after an operation like this. You will be encouraged to sit out of bed and get moving around with the help of the nurses and physiotherapists.
As the days go on, you should begin to feel better and stronger in yourself and these drips and drains will be removed. Read some general information and advice about what to expect after surgery.
Depending on the type of surgery, you may be in hospital for 5-10 days. Before you go home you will have a chest X-ray to make sure your lung is working properly.
Your nurse will check your wound to make sure it is healing and talk to you about signs of infection to look out for when you are home.
If you live alone or have problems getting around the house, speak with your nurse. They will be able to help organise any community services you need after you leave the hospital.
Shortness of breath after lung cancer surgery
You might feel a bit short of breath after surgery, as you’ll have less lung tissue to supply your body with the oxygen it needs. Usually, this gets better as the lung tissue re-expands and heals after surgery.
A physiotherapist will also show you breathing exercises. By doing the exercises, you will help to re-expand the remaining lung tissue, increase your lung capacity and get rid of excess fluid and air in your lung.
An incentive spirometer is a device that tries to exercise your lungs and improve your breathing. When you breathe in with your mouth over a mouthpiece it makes a ball in a tube rise up. The physiotherapist will ask you to try to keep the ball up at the top of the tube for a few seconds by holding your breath. Gradually you can change the settings on the device to increase the level of exercise.
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