Surgery for non-small cell lung cancer
Surgery can be used for non-small cell lung cancers that are small in size and haven’t spread. Before any surgery, you may need to have further tests to check you’re able to cope with it. Radiotherapy or chemotherapy may be given before or after surgery.
The type of operation you’ll have will depend on the size and position of the tumour.
Removal of a lobe of the lung is called a lobectomy. Removal of two lobes is called a bi-lobectomy.
Removal of a whole lung, as shown below, is called a pneumonectomy.
Depending on the type of surgery performed you may have a thoracotomy, which involves opening the chest wall.
This will leave a scar around the side of the chest. Video-Assisted Thoracoscopic Surgery (VATS) is a less invasive surgical technique that involves inserting a tube into the chest through which surgery can be performed. This leaves a much smaller scar and is associated with less post-operative pain.
People are often worried that they won’t be able to breathe properly if their lung has been removed, but it’s possible to breathe normally with only one lung. People who had breathing difficulties before the operation may continue to be breathless afterwards.
Breathing tests to measure how well your lungs work will be done to help you and your doctor decide whether an operation is right for you.
Occasionally, in people who have very early lung cancer, only a very small amount of the lung is removed. This is called a wedge resection (see above).
A segmentectomy operation removes a slightly larger part of the lung.
Before any operation, make sure that you have discussed it fully with your doctor so that you understand what it involves.
Surgery is sometimes combined with radiotherapy or chemotherapy.
It can take many weeks, or even months, to recover from a lung operation, although some people recover quicker than others. There are things you can do to help speed up your recovery.
After your operation, you’ll be encouraged to start moving about as soon as possible. This is an essential part of your recovery. Even if you have to stay in bed, it’s important to keep up regular leg movements to help your circulation and prevent blood clots.
You may be given special support stockings to wear during and after your operation, which will help prevent blood clots developing in your legs.
Your nurse or a physiotherapist will help you with breathing exercises to prevent chest infections and other possible complications.
X-rays will be taken regularly after your operation to make sure your lung is working properly.
Drips and drains
A drip (intravenous infusion) will be used to give you fluids for a couple of days, until you’re able to eat and drink normally again.
You’ll also have drainage tubes coming from near your wound. These are usually removed about 2-7 days after your operation, depending on your recovery. The wound will usually be at the side of your chest between two ribs. It will be covered with a dressing, which the nurses will check regularly.
After your operation, you’ll need painkilling drugs for a few days. These may be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.
You might wake up from your surgery with a small tube coming out of your chest wall. This can be used to deliver regional, pain-relieving medication and is known as extrapleural analgesia. The tube will stay in for about 2-3 days.
You may be given intravenous pain relief through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a handset with a button you can press if you feel sore. This is called patient-controlled analgesia (PCA). It’s designed so that you can’t have too much painkiller (an overdose), so it’s okay to press it whenever you’re uncomfortable.
It’s normal to have some pain or discomfort after your operation. This can usually be controlled with painkillers. Let the doctor or nurses know if you have any pain, so they can treat it as soon as possible.
It’s important to be as comfortable as possible so that you can breathe properly - this can reduce your risk of developing chest infections.
Mild discomfort or pain in your chest can last for several weeks or months, so you’ll be given some painkillers to take home.
Some people find that they have pain that starts some weeks or months after their operation. This is usually because nerve endings that have been damaged during the operation have started to grow back. Talk to your specialist if you start to have pain some time after your operation.
You’ll probably be ready to go home about 5-10 days after your operation. If you think that you might have problems when you go home - for example, if you live alone or have several flights of stairs to climb - it’s important to tell one of the nurses when you’re admitted to the ward. They can arrange help for when you go home.
At home, you’ll need to exercise gently to build up your strength and fitness. It’s a good idea to check with your doctor or physiotherapist which types of exercise would be suitable for you. Walking and swimming are suitable for most people after treatment for lung cancer.
Your doctor will tell you when it’s safe for you to start driving again after your surgery. It can take about 4-6 weeks for you to be fit enough to drive again. At first, you may find that the seat belt presses on your wound and makes it sore.
Some car insurance policies give specific time limits for not driving after chest surgery; you may need to check this with your insurance company.