Treating Lung Cancer: Which Surgical Option Is Best for You?

Find out what factors affect this decision

If you have lung cancer, your doctors have three options for treating it with surgery: wedge resection, lobectomy or pneumonectomy. You can find out more about these terms, but how do you know which approach is best for you?

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Many factors may affect this decision — the size of the tumor, whether the cancer has spread, and how much of your lung the surgeon needs to remove, for instance.

You’ll want to review each option in detail with your surgeon. However, another key factor is what approach your surgeon will take, says cardiothoracic surgeon Alejandro Bribriesco, MD.

“Two goals for any lung cancer surgery are to perform the best cancer operation you can and to perform it safely,” he says.

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Surgical options for lung cancer 

Here, according to Dr. Bribriesco, are the three primary options for treating lung cancer with surgery: 

  • Wedge resection— For small tumors, sometimes the surgeon needs to remove only a small part, or wedge, of your lung that contains the tumor plus a small margin of healthy tissue around the cancer. Usually this is for diagnosis, but in some instances can be used for treatment.
  • Lobectomy — You have three lobes in your right lung and two lobes in your left lung. During a lobectomy, the surgeon will remove an entire lobe from your lung that contains the cancer.
  • Pneumonectomy — In certain advanced cases of lung cancer, the surgeon will remove the entire lung that contains the cancer.

Approaches your surgeon will consider

There also are three options to consider regarding the surgical approach or how the lung is removed, Dr. Bribriesco says:

  • Thoracotomy — This traditional open approach is more invasive, but it is a safe and effective form of lung cancer surgery, he says. It typically involves an incision of six to eight inches, with some spreading of your ribs. The benefit is that it gives your surgeon good access to the lung to perform a safe and appropriate cancer operation.
  • Video-assisted thoracic surgery (VATS) — Your surgeon may use this minimally invasive surgery to perform a wedge resection or lobectomy. It requires between three and five small incisions, usually about one to three inches long. The surgeon will insert a surgical camera into one incision. This allows the surgical team to see the inside of your chest. They then insert small instruments in the other incisions to operate and remove the cancer. VATS is safe, offers you a quicker recovery time and is less painful than thoracotomy.
  • Robotic-assisted thoracic surgery — This is another minimally invasive approach that has become more common in recent years. As with VATS, the surgeon makes small incisions and the team uses a camera to view the inside of the chest. However, the surgeon controls the instruments with a surgical robot.  The robot allows for excellent visualization inside the chest and precise control of the instruments.  This procedure is also less painful and reduces the recovery time.

When minimally invasive surgery isn’t right for you

Surgeons treat most patients who have small or early-stage lung cancers with VATS or robotic-assisted surgery, Dr. Bribriesco says. But in some cases, the traditional open-chest approach is recommended. This might be the case if your tumor is very large or the cancer involves more than one lobe of the lung. Other possible reasons include:

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  • A  cancer that involves other parts of your chest, such as blood vessels or ribs
  • Previous chest surgery
  • You have received chemotherapy and radiation as part of your lung cancer treatment before surgery

Make sure you understand how your surgeon plans to approach your procedure, then keep yourself in good condition by eating well and staying active beforehand, Dr. Bribriesco says. These are the most important things you can do to set yourself up for the best possible outcome.

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