Download Surgical Treatment and the Lung Cancer Patient

Surgical Treatment and the Lung Cancer Patient
Dan Waters, DO
There are many types of lung disease and several are able to be treated with surgery. The most
commonly performed lung surgery is removal of all or part of the lung for the treatment of lung
cancer. Surgical treatment for cancer is usually reserved for patients whose tumors have not
spread beyond the confines of the lung. When disease has spread beyond the lung, such as into
distant lymph nodes or other organs, surgical removal has markedly less success in controlling
the cancer.
Surgery on the lung can be approached in several ways. “Open” surgery is done through a chest
incision between the ribs – this is called a thoracotomy. Some open procedures can be done with
relatively small incisions (“minimally invasive”) and some can be performed with the insertion
of scopes and instruments through very small incisions or “ports” (thorascopic or video-assisted
surgery).
The most common operation performed for lung cancer is called a lobectomy. Each lung is
divided into several major sections or “lobes” and each lobe is supplied by a major branch or
branches of the pulmonary artery and vein and a major airway tube called a bronchus. Removal
of a lobe, regardless of the approach, requires careful identification and control of these
structures before the lobe can be removed. Sometimes only part of the lobe is removed – this
can be done with what is called a “segmentectomy” in which a defined anatomic portion of a
lobe is removed or with a “wedge” resection which involves removal of a portion of a lobe
usually containing a mass or tumor along with surrounding normal lung tissue.
In some cases, such as when a tumor is very close to the heart where the arteries and veins
originate, the entire lung is removed. This is called a “pneumonectomy”.
The decision to perform any of these procedures is made on a very individualized basis. It takes
into account the location of the tumor, it’s relation to the surrounding structures, the patient’s
underlying lung function, their general medical condition and the likelihood of obtaining a cure.
In conjunction with removal of all or part of the lung, lymph nodes are removed to see if the
tumor has spread to them. There are many lymph nodes scattered throughout the chest and
whether or not they contain tumor cells is important in ‘staging’ the tumor and guiding further
treatment. Some larger tumors, or those where spread is identified into the local or regional
lymph nodes may require follow-up therapy either with radiation and/or chemotherapy to obtain
the best long-term result.
The surgical treatment of lung cancer is undertaken with the help of a group of physicians who
discuss each case; this group includes not only a lung surgeon but also medical lung specialists,
radiation oncologists, medical oncologists, and lung radiologists along with the pathologist. In
this manner, care and treatment is individualized to try and provide each patient with the best
outcome at the lowest risk.