Lung cancer surgery is the treatment of choice for early stages of the disease. Lung cancer is a devastating disease that affects millions of people worldwide. In India, the prevalence of lung cancer is on the rise, making it crucial to understand the available treatment options. One of the most effective approaches to combating lung cancer is through surgery. This article will provide a comprehensive guide to lung cancer surgery, discussing the types of surgeries available, the factors that determine the suitability of each procedure, and the potential risks and benefits associated with them.
Understanding Lung Cancer Surgery
Surgery plays a significant role in the treatment of lung cancer, particularly for early-stage disease. The primary goal of lung cancer surgery is to remove the cancerous tumor and any nearby lymph nodes, offering the best chance of a cure. However, it is important to note that surgery is not suitable for every patient and should only be performed by experienced surgeons in specialized centers.
Before undergoing lung cancer surgery, several tests will be conducted to assess your overall health and determine if surgery is a viable option. These tests include pulmonary function tests to evaluate lung function, assessments of heart and organ function, and lymph node evaluation through techniques such as mediastinoscopy or EBUS. A PET scan would aslo be done to see if the cancer is limited to the lungs or has spread to other organs.
Types of Lung Cancer Surgery
Different types of surgeries can be performed to treat non-small cell lung cancer (NSCLC), the most common form of lung cancer. These surgeries are typically performed under general anesthesia and involve making an incision in the chest or back. The specific type of surgery recommended will depend on factors such as tumor size, location, and lung function.
- Pneumonectomy: This surgery involves the removal of an entire lung and is typically necessary when the tumor is located close to the center of the chest.
- Lobectomy: The lungs are comprised of lobes, with three on the right side and two on the left side. A lobectomy entails removing the entire lobe containing the tumor(s) and is often the preferred surgical approach for NSCLC when feasible.
- Segmentectomy or Wedge Resection: In some cases, only a portion of a lobe needs to be removed. Segmentectomy or wedge resection surgeries involve the removal of specific segments of a lobe. This approach may be considered if a patient has limited lung function and cannot withstand the removal of an entire lobe.
- Sleeve Resection: This operation is employed for certain lung cancers affecting the large airways. It involves removing the tumor along with a section of the airway, followed by reconnecting the remaining parts. Sleeve resection can be an alternative to pneumonectomy, preserving more lung function.
Approaches for Lung Cancer Surgery
There are three main surgical approaches for lung cancer namely:
Open Surgery (Thoracotomy)
Video Assisted Thoracocscopic Surgery (VATS)
Robotic Assisted Thoracoscopic Surgery (RATS)
Intraoperative Imaging: Enhancing Precision
During lung cancer surgery, surgeons rely on their visual and tactile senses to identify and remove the tumor. However, certain tumors may be difficult to locate or may be missed entirely. To address this challenge, intraoperative imaging techniques have been developed.
One such technique involves the use of a fluorescent drug called pafolacianine (Cytalux) to enhance tumor visibility. Prior to surgery, the drug is injected into the patient’s bloodstream. It travels throughout the body and attaches to a specific protein found on lung cancer cells. In the operating room, an imaging system emits near-infrared light, causing the drug to fluoresce. This fluorescence aids the surgeon in identifying the areas of the lung that need to be removed with greater precision.
Intraoperative imaging using pafolacianine can be a valuable tool in lung cancer surgery, allowing surgeons to detect tumors that may not be easily visible or palpable. However, it is important to note that this technique has potential side effects, including abdominal pain, heartburn, itching, chest pain, nausea, vomiting, and flushing. Prior to the procedure, patients may be advised to avoid certain supplements containing folic acid, as they can interfere with the drug’s efficacy.
Procedure and Postoperative Care
Lung cancer surgery is a major operation that carries potential risks and side effects. It is essential to understand the procedure and what to expect during the recovery period.
Following surgery, patients will wake up with tubes inserted into their chest, which are connected to a drainage system. These tubes allow excess fluid and air to drain out and are typically removed once the drainage decreases. Hospitalization after lung cancer surgery generally lasts between 5 to 7 days.
Recovery from lung cancer surgery can take several weeks to months. Patients who undergo a thoracotomy, which involves a large incision in the chest, may experience pain around the incision site for some time after the surgery. Physical activity may be limited for a month or two. In contrast, patients who undergo minimally invasive procedures, such as VATS (Video-Assisted Thoracic Surgery) or robotic-assisted surgery, often experience less pain and faster recovery.
It is important to note that individuals with pre-existing lung conditions, such as emphysema or chronic bronchitis, may experience shortness of breath during certain activities after surgery.
Advancements in Minimally Invasive Lung Cancer Surgery
In recent years, there have been significant advancements in minimally invasive surgical techniques for lung cancer. These procedures, such as VATS and robotic-assisted thoracic surgery (RATS), offer several advantages over traditional open surgeries.
- Video-Assisted Thoracic Surgery (VATS): VATS, also known as thoracoscopy, is a minimally invasive procedure that utilizes small incisions and a thoracoscope (a thin, flexible tube with a camera) to visualize and access the lungs. VATS allows surgeons to remove lung tumors with minimal damage to surrounding tissues. This technique typically results in shorter hospital stays and reduced complications compared to open surgeries.
- Robotic-Assisted Thoracic Surgery (RATS): RATS utilizes a robotic system controlled by the surgeon to perform lung cancer surgery. The surgeon operates through small incisions in the chest, using robotic arms to maneuver surgical instruments with enhanced precision and flexibility. RATS offers benefits such as reduced pain, blood loss, and recovery time.
Minimally invasive surgeries, such as VATS and RATS, have become increasingly popular in the treatment of lung cancer. These procedures minimize trauma to the chest, resulting in faster recovery and improved patient outcomes. However, it is important to note that the success of these surgeries relies heavily on the experience and skill of the surgeon.
Risks and Side Effects of Lung Cancer Surgery
Lung cancer surgery is a major procedure that carries potential risks and side effects. While all surgeries involve some degree of risk, the extent of these risks depends on factors such as the type and extent of the surgery, as well as the patient’s overall health.
Possible complications during and after surgery may include reactions to anesthesia, excessive bleeding, blood clots in the legs or lungs, wound infections, and pneumonia. It is important to note that in rare cases, some individuals may not survive the surgery.
Recovery from lung cancer surgery can be a challenging process. Pain and discomfort around the incision site are common, particularly in cases where a thoracotomy was performed. Your activity levels may be limited for a period of time, and it is important to follow your surgeon’s instructions for postoperative care and rehabilitation.
Patients with good lung function can usually return to normal activities after a lobe or even an entire lung is removed. However, individuals with pre-existing lung conditions may experience shortness of breath during certain levels of activity following surgery.
Surgery for Lung Cancer that has Spread to Other Organs
In cases where lung cancer has spread to other organs, surgical intervention may still be an option. However, this depends on several factors, including the location and extent of the tumor. If the lung tumor and brain tumor can both be removed or treated effectively, surgery may be recommended to remove the brain tumor. This procedure, known as a craniotomy, involves removing the tumor through a small hole in the skull.
It is crucial to note that surgery for lung cancer that has spread to other organs is a complex decision that requires careful consideration by a multidisciplinary team of specialists. The goal is to provide the most effective and personalized treatment plan for each patient.
Lung cancer surgery is a crucial treatment option for individuals with lung cancer, offering the best chance of a cure, particularly for early-stage disease. Various types of surgeries, including lobectomy, pneumonectomy, segmentectomy, and wedge resection, can be performed depending on the size, location, and stage of the tumor. Minimally invasive techniques, such as VATS and RATS, have revolutionized lung cancer surgery, providing patients with faster recovery times and reduced complications.
However, it is important to remember that lung cancer surgery is a major procedure that carries potential risks and side effects. Each individual’s case is unique, and surgical intervention should be carefully considered in consultation with a team of experienced lung cancer specialists. By understanding the available treatment options and working closely with your healthcare team, you can make informed decisions about your lung cancer treatment and improve your chances of a successful outcome. Feel free to book a consult with Dr. Kamran Ali to formulate the best treatment plan for your loved ones.