June 22, 2024

Lung Cancer Surgery: Lifesaving Treatment with Risks

Surgical removal of the cancerous lung tissue, known as lung cancer surgery, offers the best chance of cure for many patients. However, it also carries risks that patients should be aware of.

Types of Lung Cancer Surgery

There are different types of lung cancer surgery depending on the location and size of the tumor. The main types are:

Wedge resection: This involves removing a wedge-shaped section of the lung around the tumor. It is used for small, peripheral tumors.

Lobectomy: This surgical procedure removes an entire lobe of the lung, either the upper or lower lobe. It is the most common type of lung cancer surgery performed for tumors located centrally in the lung.

Pneumonectomy: For larger central tumors, a pneumonectomy may be needed which removes an entire lung. This more extensive surgery has greater risks than lobectomy.

Sleeve lobectomy: In some cases where the tumor is too close to the main branches of the bronchus, a sleeve lobectomy can be done which removes the tumor along with a part of the bronchus. The remaining lung tissue is reconnected.

Goals and Benefits of Lung Cancer Surgery

The primary goal of lung cancer surgery is to remove all visible signs of cancer from the lungs. It aims at achieving clear margins, which means removing the tumor along with a clear rim of healthy tissue surrounding it to minimize the risk of cancer recurrence locally.

When successful complete tumor resection is achieved, it offers the best chance of cure for early-stage non-small cell lung cancer (NSCC) which accounts for about 85% of lung cancers. Five-year survival rates after complete tumor removal range from 50-70% for stage 1 NSCC.

Surgery may also potentially prolong survival or palliate symptoms in select patients with more advanced lung cancer. Rarely, it can even cure metastatic disease if all sites of cancer spread are resectable.

Risks of Lung Cancer Surgery

While curative for early-stage disease, lung cancer surgery also carries certain risks due to the critical function of lungs and proximity of major blood vessels and airways. Some potential complications include:

– Air leak: In about 10-15% of cases, an air leak from the lung may occur which causes collapsed lung (pneumothorax). It usually heals on its own with chest tube drainage but sometimes needs pleurodesis.

– Bleeding: Significant bleeding requiring blood transfusion develops in 3-5% of surgeries. It can sometimes lead to re-operation.

– Infection: Post-operative pneumonia and wound infections affect 2-5% of cases. They are treated with antibiotics.

– Atelectasis: Parts of the remaining lung may collapse in 10-15% patients due to mucus plugging, requiring chest physiotherapy.

– Arrhythmias: Disturbances in heart rhythm like atrial fibrillation occur in about 10% of surgeries.

– Hospital stay: Average hospital stay after surgery ranges from 5-10 days but high-risk patients may need longer care in the hospital.

– Mortality: In-hospital deaths occur in 1-3% of surgeries, usually due to above complications or coronary issues in elderly patients. Pneumonectomy has a higher mortality risk of 3-5%.

– Poor lung function: Parts of the remaining lung may not expand well after surgery in 10-20% patients, worsening breathing long-term. This impacts quality of life.

Balancing Risk-Benefit for Lung Cancer Patients

Given the above risks, lung cancer surgery is not undertaken lightly. Patients’ overall health, pulmonary function, specific tumor factors and stage of disease are carefully evaluated to see if the potential benefits outweigh the risks for that individual.

In borderline or high-risk cases, pre-operative optimization with smoking cessation counseling, breathing exercises, antibiotics and nutritional supplements may help reduce risks and expand candidacy for potentially curative surgery whenever possible.

For very early-stage NSCC patients who are not fit for surgery due to poor pulmonary function, non-surgical alternatives like stereotactic ablative radiotherapy offer comparable chances of cure with less risk.

Overall, lung cancer surgery offers the single best chance of long-term survival for appropriately selected patients. By being aware of both potential benefits as well as risks, patients can make well-informed treatment decisions in consultation with their thoracic surgeon. With improved surgical techniques and post-operative care over time, outcomes continue to improve giving hope to many with this challenging disease.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it