Thoracic Oncology Program

Patient and Family Education

Lung Cancer

Lung Surgery for Cancer

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Surgical Resection

Lung surgery for cancer includes the removal of the tumor, lymph nodes and sections of the lung that contain the tumor. It is the treatment of choice in several types and stages of lung cancer, either alone, or in combination with chemotherapy or radiation therapy. It is also used to remove cancerous tumors that have spread to the lungs from other parts of the body. The surgeon will recommend one of several approaches for removal of the tumor.

Surgical Approach

Thoracoscopy (also called VATS -- Video Assisted Thoracic Surgery) - A minimally invasive technique. Three small (approximately 1 inch) incisions are made in your side. A video-scope is placed through one of the incisions. This scope allows the surgeon to see your lungs. A stapler and grasper are inserted in the other incisions. The tumor is removed through a plastic bag in order to prevent the spread of cancer. The incisions are closed by sutures, which will eventually dissolve. Thoracoscopy is used when the tumor is small and located on the outer edges of the lungs.
Thoracotomy - Thoracotomy is used when the tumor is not accessible with the thoracoscope. An incision is made in your side, between your ribs. The incision is approximately 7 to 9 inches long. Your ribs are separated and one may be cut. The tumor, lymph nodes and surrounding lung are removed. Your muscle and skin are closed with sutures or staples.
Modified approach - Sometimes conventional approaches need to be modified in order for the tumor, lymph nodes and affected lung to be adequately removed. Your surgeon will describe the specific approach to be used for you.

Results

No matter which approach is used, the surgeon will remove the tumor and send it to pathology for analysis. The pathologist will inspect the tissue for cancer cells. The final pathology report usually takes 10 to 14 days. The surgeon will notify you of your diagnosis as soon as he knows the results, or at your follow-up appointment, 2 weeks after discharge.

Risks & Potential Complications

The main risks of lung surgery for cancer are: prolonged air leak (see below), pneumonia or infection, bleeding, need for a blood transfusion, stroke, heart attack and death. Preoperative chemotherapy and /or radiation therapy can increase the chance of these risks.

Prolonged air leak

No matter which approach is used, one or more chest tubes will be placed in your side during the operation. These tubes drain fluid and air from around the lungs. Most patients have an air leak after lung surgery. This happens when air from the lung tissue (usually at the internal suture line) leaks out into the chest cavity. If the volume of air inside the chest becomes too great, the pressure could cause the lung tissue to collapse. The chest tubes prevent this from happening. Most air leaks stop within 3 to 5 days after surgery. When they last longer, it is called a prolonged air leak. This is the most common complication of chest surgery. These leaks always heal, but it can mean you will need to stay in the hospital longer than expected.

Thoracoscopy

Expect to stay approximately 3 to 5 days on the Cariothoracic Surgery Unit (6 Gudelsky). Once there is no longer air leaking from your chest tubes, they will be removed and you will be able to go home. Your family can visit you between the hours of 11am and 8pm.

Thoracotomy

Expect to stay 3 to 7 days on the cariothoracic surgical units. You may be in the intensive care unit for one or two days before you are transferred to the floor. Once there is no longer air leaking from your chest tubes, they will be removed and you will be able to go home. Your family can visit you in the ICU or the floor between the hours of 11am and 8pm.

Chest Tubes

During surgery, one or more chest tubes will be placed into your side. These chest tubes are used for drainage and to monitor air leakage. The tube is hooked up to an empty container, which will collect any fluid that drains out from your chest. The chest tube will remain in until the drainage stops and there is no air leakage.

Pain Control

Operations create pain. We make every effort to minimize your discomfort through oral medications, IV medications and epidural catheters. You will be asked frequently about your pain. Please be honest. It is very important for the pain to be under control because taking deep breaths and moving are essential for quick recovery.

PCA (Patient Controlled Analgesia): This is pain medicine that is given through your IV. You will be able to press a button connected to the pain medicine and dose yourself as needed. You do not need to worry about overdosing or becoming addicted. Limits will be programmed into the pump and you will not become dependent while you are having real pain.
Epidural Catheter: This is a very small tube placed in your back at the time of surgery. Pain medication is infused through the catheter, which will bathe the spinal cord and prevent pain. You may have a PCA button for your epidural pain medicine (see above).
Oral medications are most often given on an "as needed" schedule. This means that you must ask the nurse to give you the medicine. Usually, there is a 4 hour interval between doses. Please let your nurse know if you need your medicine more frequently or if it makes you too sleepy.

Deep Breathing, Coughing & Incentive Spirometry

It is very important to cough and deep breath after surgery. Your lungs need to be fully expanded to prevent infection and collapse. Please practice coughing and deep breathing before you come in for surgery.

Deep breathing: fill you lungs up slowly over a count of 5, hold for a count of 5, exhale slowly over a count of 5. REPEAT 10 TIMES per hour while you are awake.
Coughing: take two slow breaths filling your lungs up as much as possible. Begin your cough as you exhale the second time. Make sure you hold a pillow or towel over your incision (also called "splinting" your incision) during your cough. This will decrease the pain. REPEAT 10 TIMES per hour while you are awake.
Incentive Spirometry: Hold the spirometer securely in two hands and place your mouth on the mouth piece. Exhale around the mouth piece and make a tight seal on the mouthpiece. Inhale slowly to the count of 5 while you watch the disc move upward. Hold for a count of 5, loosen the seal around the mouthpiece & exhale. REPEAT 10 TIMES per hour while you are awake.

Activity

Walking and moving frequently are very important components of your recovery. The more you push yourself to exercise and move, the quicker and less painful your recovery will be. You may not feel up to moving, BUT YOU MUST. You will be up in the chair the night of surgery and walking in your room the next morning.

This page was last updated on: November 10, 2010.