Types of Lung Cancer Surgery
There are three main types of surgery that can be used to treat non-small cell lung cancer depending on the size and location of the tumor. The first is a wedge resection where only a portion of the lung is removed. This is typically used for small tumors near the edge of the lung. The surgeon makes a cut into the lung and removes the tumor along with a wedge of healthy lung tissue around it.
Lobectomy is another common procedure where an entire lobe of the lung is removed. The lungs are divided into three lobes on the right side and two lobes on the left side. A lobectomy may be needed for larger tumors or those located deeper in the lung tissue. By removing the entire lobe, doctors can be sure to remove any cancer cells that have spread beyond the visible tumor.
For cancers at the center of the Lung Cancer Surgery or that have spread to various parts of the lung, a pneumonectomy may be required where an entire lung is removed. This is a more invasive surgery but can still potentially cure the cancer if all visible signs of the disease can be removed. Pneumonectomies carry higher risks than wedge resections or lobectomies due to less remaining lung tissue after surgery.
Preparing for Lung Cancer Surgery
Before undergoing sleeve lobectomy, patients will have various tests to stage the cancer and evaluate their health status. This includes CT scans, PET scans, and often a bronchoscopy where a thin, lighted tube is inserted through the mouth to examine the airways. Laboratory tests of blood and liver and kidney function are also checked.
Doctors will determine if a patient is healthy enough to withstand removing part or all of a lung. They must have sufficient heart and lung reserve to function with less capacity after surgery. Patients with other severe health issues like heart disease may not be candidates for surgery. Smokers are also advised to quit smoking for several weeks before and after surgery to help the lungs heal properly.
The Surgical Procedure
When the patient is deemed fit for surgery, the procedure takes place in an operating room under general anesthesia. The surgeon will make a long incision between the ribs and remove a portion of the chest wall. Larger surgeries like a pneumonectomy require breaking the breast bone as well.
The lung is then detached from surrounding structures like the mediastinum, trachea, heart, and diaphragm. Hilar structures where blood vessels enter the lung are divided between clips or staples. Bleeding sites are cauterized. With a wedge resection, only the tumor plus some surrounding healthy lung are removed. For larger procedures, an entire lobe or whole lung is withdrawn from the chest cavity.
Lymph nodes near the lung may also be removed and checked for signs of cancer spread. Staples or sutures are used to close all openings and a chest tube is inserted to drain fluid and help the lung re-expand. The incision is then closed with absorbable sutures or surgical staples. The surgery usually takes 2 to 5 hours depending on the procedure.
Post-Operative Recovery
After sleeve lobectomy, patients are monitored in the hospital's post-anesthesia care and surgical units. Doctors watch for bleeding, infections, or problems with fluid drainage from the tube. Most people stay in the hospital for 4 to 7 days as they regain strength and lung function.
Pain is initially managed with intravenous medications but patients transition to oral pain relievers. Breathing exercises start on the first day to expand the lungs and prevent complications. The chest tube is removed once drainage decreases significantly, usually 3 to 7 days after surgery. Stitches or staples are removed within 10-14 days.
A follow up visit with the thoracic surgeon occurs within a few weeks. Recovery at home takes 6 to 8 weeks as incisions heal completely. Patients should avoid heavy lifting or strenuous activities initially. Lung capacity slowly returns to normal over several months with exercises and lifestyle changes like quitting smoking. Further chemotherapy or radiation may be recommended based on cancer staging.
Outcomes of Sleeve lobectomy
Sleeve lobectomy can successfully treat non-small cell lung cancer if the entire tumor plus involved lymph nodes have been removed. This potentially cures the disease. Five-year survival rates are highest when cancers are caught early at stage IA, ranging from 70-92%. But even stage II-III cancers have survival rates of 30-70% with complete resection.
Survival rates depend on factors like the stage, size, and involvement of lymph nodes along with the patient's overall health. However, sleeve lobectomy offers the best chance at a cure compared to other treatments. While surgery carries risks like bleeding and infections, improved approaches have lowered mortality rates to less than 3% at most major cancer centers today. Careful patient selection and experience of the surgical team also affects outcomes. With follow up care, surgery has given many people with lung cancer more years of good quality life.
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