Surgery for Lung Cancer

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MSK thoracic surgeon Gaetano Rocco in the OR

Thoracic surgeon Gaetano Rocco will work with a team of experts to create a treatment plan tailored to your unique needs.

The goal of surgery for lung cancer is to remove all the cancer. We remove the part of the lung that has cancer and the nearby lymph nodes (also called lymph glands). At Memorial Sloan Kettering Cancer Center, your surgeon’s top priority is your safety. We also make sure you have a good quality of life after surgery.

At MSK, more than 90% of lung cancer surgeries for early-stage disease use minimally invasive approaches such as video-assisted thoracic surgery (VATS) and robotic-assisted surgery.

As a surgical patient at MSK, you will be cared for by one of the country’s most experienced lung cancer teams. Our surgeons perform more than 1,200 lung cancer operations each year. Our patients have among the lowest complication rates after surgery in the country.

MSK is an NCI-designated cancer center, which means it meets the strict standards of the National Cancer Institute. For all cancer stages, people treated for lung cancer at centers like MSK have better survival rates compared with national benchmarks.

Our surgeons’ goal is to spare the lung. They will remove the cancer and save the rest of the lung tissue whenever possible. When possible, we recommend methods that are less invasive. Minimally invasive surgery uses small incisions (cuts) and few stitches, with less damage to nearby tissue. At MSK, more than 3 out of 4 lung cancer resections (tumor removals) use minimally invasive procedures. This can help speed recovery, and it means fewer complications.

 

Non-Small Cell Lung Cancer Treatment

Some people have non-small cell lung cancer that is only in 1 lung. The best chance for a cure is surgery to completely remove the tumor. This procedure is called a lobectomy. It is the most common type of operation for people who have this kind of lung cancer. For some people with early-stage non-small cell lung cancer, surgery may not be the best option. We may recommend stereotactic body radiation therapy. This treatment can remove small lung lesions.

Some people have advanced non-small cell lung cancer that has spread to the lymph nodes. However, it is still only in the chest. Surgery may not be an option because of the tumor’s location or your general health. We may recommend radiation therapy. It’s best given with chemotherapy.

Small Cell Lung Cancer Treatment

Surgery is rarely part of the treatment plan for small cell lung cancer. The disease can spread quickly and responds well to chemotherapy and radiation therapy. Sometimes, surgery to remove small cell tumors is an option, especially if the cancer is found early. MSK surgeons are skilled in removing small tumors. This includes both small tumors near the outside of the lung, and ones that have not spread beyond the lung.

Patients who can have surgery for small cell lung cancer usually get adjuvant chemotherapy. This is chemotherapy given after surgery. This approach improves cure rates compared with having surgery only.

 

Types of Lung Cancer Surgery

The procedure used will depend on the size of the tumor. It also depends on where the cancer has spread within the lungs, which are made up of lobes. Your left lung has 2 lobes and your right lung has 3 lobes. These are common surgical procedures to treat lung cancer:
 

  • Sublobar operations include surgery to remove parts of the lung within 1 lobe. A wedge resection is the removal of a small part of a lobe. A segmentectomy is the removal of 1 or more parts of a lobe.
  • lobectomy is the removal of an entire lobe of the lung. This is the most common surgery for non-small cell lung cancer.
  • bilobectomy is the removal of 2 lobes of the right lung. It involves the upper and middle lobes, or the middle and lower lobes.
  • pneumonectomy is the removal of an entire lung. It is done when the cancer is in the center of the lung and cannot be removed with other types of surgery. A pneumonectomy is only for patients who have good lung function and will have enough oxygen.

 

Minimally Invasive Surgery for Lung Cancer

Today, most lung cancer operations use minimally invasive surgery. Minimally invasive surgery uses small incisions (cuts) and few stitches. It lets surgeons remove all the cancer, with less damage to nearby tissue. This method helps speed recovery and reduce complications. It can help people with other health conditions that make traditional surgical procedures too risky.

At MSK, more than 3 out of 4 lung cancer resections (tumor removals) use minimally invasive surgery. These include thoracoscopy (also called Video-Assisted Thoracic Surgery, or VATS) and robot-assisted surgery. MSK surgeons helped develop these minimally invasive methods. MSK does more than 440 minimally invasive surgeries each year, making it one of the busiest cancer centers for these procedures.

Sandra’s Story: How Minimally Invasive Surgery Maximizes Recovery from Lung Cancer
Meet Sandra Lowe, who was diagnosed with lung cancer in February 2021 and was treated successfully at Memorial Sloan Kettering Cancer Center.

 

Video Assisted Thoracic Surgery (VATS)

Our surgeons are very experienced in video-assisted thoracic surgery, or VATS. This procedure is also called thoracoscopy. The usual chest surgery is called an open thoracotomy. This surgery involves making a big incision (cut) in the chest. The ribs are spread apart to reach the lung.

With VATS, however, our surgeons use a few small incisions to put a telescope camera inside the body. They use special instruments to operate on the lung and chest without spreading or breaking the ribs.

The VATS procedure is used with only 3 out of 10 eligible cancer cases in the U.S. But at MSK, we use VATS with nearly 6 out of 10 people who have lung cancer. This minimally invasive surgery results in faster recovery. It lets people who need more treatment, such as chemotherapy or radiation therapy, start it more quickly.

VATS has many benefits compared to an open thoracotomy. They include:

  • Less time you need chest tube drainage
  • A shorter hospital stay
  • Less pain
  • Fewer complications, especially for frail patients

Our thoracic (lung) surgeons use the VATS approach for: 

  • Wedge resections (removal of the tumor and a small part of a lobe of the lung)
  • Segmentectomy (removal of 1 or more parts of a lobe that has the tumor)
  • Lobectomy (removal of the tumor and an entire lobe of the lung)
  • Bilobectomy (removal of the tumor and 2 lobes of the right lung)
Robotic Surgery (Robot-Assisted Surgery)

Robotic-assisted surgery for lung cancer is a type of video-assisted thoracic surgery, or VATS. This procedure is minimally invasive. This means it uses small incisions (cuts) and few stitches, with less damage to nearby tissue. Our surgeons use a 3-D visual system so they can see the chest clearly. This robotic surgical system lets them do complex surgery using a few small incisions (cuts). They use special flexible instruments to operate on the lung and chest without spreading or breaking the ribs.

Robotic-assisted surgery is the fastest-growing kind of surgery for lung cancer. It has all the benefits of minimally invasive VATS. MSK surgeons were among the first to use robotic-assisted VATS for lung surgery. We developed the method for this procedure, and today it’s used around the world. MSK is among the busiest cancer centers for robotic chest surgery. We continue to take a leading role in performing and improving these procedures. Our surgeons use robotic-assisted surgery for:

  • Segmentectomy (removal of 1 or more parts of a lobe that has the tumor)
  • Lobectomy (removal of the tumor and an entire lobe of the lung). For lung cancer that has not spread, MSK developed a method for using a robotic surgical system during a VATS lobectomy.
  • Bilobectomy (removal of the tumor and 2 lobes of the right lung)
  • Sleeve resection, a complex surgery to remove cancer while saving the healthy part of the lung. The tumor and 1 lobe are removed. We rebuild the bronchus (the breathing tube that connects the windpipe to the lung).