When is surgery used for lung cancer?

Your doctor will explain if surgery is a possible treatment for you. It depends on:

  • the type of lung cancer
  • its stage
  • your general health.

Lung cancer surgery is a serious operation and you need to be well enough to cope with it. Before you have surgery, your doctor arranges tests to check how well your lungs and heart are working.

Your operation will be done by a surgeon who is an expert in lung surgery. Surgery for lung cancer involves removing the cancer and the lymph nodes in the chest.

Surgery may be done if you have:

After surgery, the doctor will be able to let you know more about the stage of the cancer.

You may have other treatments before or after surgery. Some people have chemotherapy or radiotherapy after surgery. But if the cancer is bigger (stage 3a) you may have chemotherapy and radiotherapy together (chemoradiation) before surgery. The operation is done 3 to 5 weeks after this finishes to allow you time to recover before surgery.

Types of surgery for lung cancer

There are three main types of operation to remove lung cancer. The type of operation you have depends on the size and position of the cancer.

Removing a lobe of the lung (lobectomy)

This is an operation to remove one of the lobes of the lung (called a lobectomy). About a third to a half of your lung (30% to 50%) will be removed. It is the most common operation for lung cancer.

Removing one of the lobes of the lung (lobectomy)
Image: Removing one of the lobes of the lung (lobectomy)

Removing two lobes of the lung (bilobectomy)

This operation is done when more lung tissue needs to be removed. It may be done if the tumour has spread to two lobes next to each other. The operation is sometimes called a bilobectomy.

Removing all the lung (pneumonectomy)

Some people may need to have the whole lung removed. The operation is called a pneumonectomy. It may be done when:

  • the cancer is near where the airways enter the lung
  • more than one lobe of the lung is affected.

You can still breathe normally with only one lung. If you had breathing difficulties before the operation, you may still have them afterwards.

Removing one of the lungs (pneumonectomy)
Image: Removing one of the lungs (pneumonectomy)

Removing a small part of the lung (wedge resection)

Sometimes the surgeon removes a very small amount of a lobe of the lung. This operation is sometimes called a sublobar resection or a wedge resection. You may have this operation if:

A segmentectomy is another type of operation that removes a slightly larger part of the lung than a wedge resection.

Removing a small part of the lung (wedge resection)
Image: Removing a small part of the lung (wedge resection)

Removing the lymph nodes

During surgery to remove the cancer, the surgeon also removes lymph nodes close to the cancer. These are examined under a microscope to check for cancer cells. Knowing if the cancer has spread to the lymph nodes tells your doctor.

How surgery for lung cancer is done

There are different ways of doing surgery for lung cancer. Your surgeon will explain which one is most suitable for you.

Open surgery

Surgery for lung cancer usually involves opening the chest between your ribs and sometimes cutting a rib. This is called a thoracotomy. You will have a scar around the side of your chest afterwards. The scar will be 10cm to 20cm long.

Video-assisted thoracoscopic surgery (VATS)

Sometimes surgeons use a type of keyhole surgery called video-assisted thoracoscopic surgery (VATS). It is only done by surgeons who are specially trained. This type of surgery may be more suitable for people with early stage lung cancer.

The surgeon makes one or several small (2cm) cuts in the skin and puts a thoracoscope (tube) with a video camera attached into the chest. The camera sends images of the inside of the chest to a computer screen.

The surgeon then passes small instruments through the cuts to remove the cancer.

After VATS you have a much smaller scar than with open surgery. You may have less pain and recover faster than with open surgery. Your stay in hospital is usually shorter. Your doctor and nurse will tell you what to expect after VATS surgery.

Before your operation

Before your operation, you may have an appointment at a pre-operative assessment clinic. You have tests to check how well your lungs are working and tests to check your general health. These may include:

  • blood and urine tests
  • lung function (breathing) tests
  • a chest x-ray
  • a recording of your heart (ECG).

Some people have more heart tests. Your doctor will explain if you need these.

At this appointment, you can ask questions and talk about any concerns you have about the operation. The nurse may show you some simple breathing exercises to help with your recovery after surgery.

When you have the surgery, you go into hospital on the day of your operation or the day before. The nurses give you elastic stockings (TED stockings) to wear during and after surgery, to help prevent blood clots. We have more information about preparing for surgery.

Stopping smoking

If you smoke, your doctor and nurse will advise you to stop smoking a few weeks before your operation. This reduces the risk of breathing problems and other complications after surgery. It may help you recover more quickly and spend less time in hospital.

We have more information about stopping smoking.

After your operation

After your operation, you usually go back to the same ward you were admitted to. Or you may be looked after in an intensive-care or high-dependency unit for a few days.

The nurses and your physiotherapist will encourage you to start moving around as soon as possible. This is very important to help with your recovery. They will encourage you to go for short walks as soon as you can.

Even if you have to stay in bed, it is important to move your legs regularly. This helps your circulation and prevents blood clots.

Your breathing

The nurse may give you oxygen through:

  • a mask over your mouth and nose
  • thin, soft tubes in each nostril.

A physiotherapist or nurse will show you some simple breathing exercises to do. This helps prevent chest infections and other possible complications.

You will have regular x-rays to make sure your lung is working properly.

Pain

It is normal to have some pain or discomfort. But there are different ways it can be managed.

Your nurse will assess you to make sure your pain is well controlled. This is also important to allow you to do your breathing exercises. Tell your nurse or doctor if the pain is not controlled. They can increase your painkillers.

For the first few days after surgery, you may have painkillers in one of the following ways:

  • Into a vein (intravenously)

    This will go into your hand or arm, through a drip (infusion) or a syringe connected to a small pump. These are set to give you a continuous dose of painkillers safely. You may be able to give yourself more painkiller when you need it by pressing a button. This is called patient-controlled analgesia (PCA).

  • Into the space around your spinal cord (an epidural)

    A surgeon puts a thin tube into your back during surgery, to deliver painkillers.

  • Into the chest area (a paravertebral block)

    A surgeon puts a thin tube into your chest during surgery, to deliver painkillers.

By the time you go home, you will be taking painkiller tablets, which you will continue to take at home. You may have mild discomfort or pain in your chest. This can last for up to several weeks or months after surgery.

Some people get new pain or an unusual sensation weeks or months after their operation. This is usually caused by nerves starting to repair after surgery. Tell your doctor or nurse about any new pain or sensations. They can check it and make sure you have the right painkillers.

Drips and drains

After your operation, you will probably have the following tubes:

  • A drip (infusion)

    This will go into a vein in your hand or arm to give you fluids. It is removed once you are eating and drinking normally again.

  • A chest drain

    You may have one or more tubes into your chest to drain fluid and air into a big bottle. Your nurse usually removes it after a few days.

  • A tube (catheter)

    This is a small tube into your bladder to drain urine into a bag. Your nurse usually removes it when you start walking.

Your wound

You usually have your stitches, clips or staples removed about 7 to 10 days after your operation. Or if you have dissolvable stitches, they disappear over a few weeks.

Your nurses and surgeon check your wound regularly while you are in hospital. Tell them if:

  • you have any redness, pain or swelling
  • the wound feels hot
  • there is any fluid leaking
  • you are feeling unwell with a fever.

These are possible signs of a wound infection. Tell your nurse or doctor if you have any of these symptoms after you go home.

We have more information about what happens after surgery.

Recovering after surgery for lung cancer

Going home

You will usually be ready to go home 3 to 7 days after your operation.

You will have an appointment to come back to the outpatient clinic a few weeks later. At this appointment, the doctor checks to see if your wound is healing and you are recovering well. They talk to you about the results of your operation and any more treatment you might need. You can also ask any questions you have.

Recovering

It may take weeks or months to recover, depending on the operation you had. Recovery takes time and it is faster for some people than others. Try to pace yourself and do not do too much too soon.

Your doctor and nurse will give you advice on what you can do to help your recovery. You need to avoid any heavy lifting, or straining your arm on the affected side. It is also important to keep doing the exercises the physiotherapist showed you. For example, they may have shown you breathing exercises to do at home.

You can slowly build up your strength and fitness with light exercise, such as short walks.

Try to:

  • eat healthily
  • get enough rest
  • do light exercise.

Keep taking your painkillers as you were told to by the pharmacist. Contact the hospital if the pain is not controlled, or if you have any problems with your wound.

You can have sex again when you feel comfortable doing so.

Driving

Your doctor will tell you when it is safe to drive after your operation. It can take about 4 to 6 weeks for you to be fit enough. At first, you may find the seatbelt presses on your wound and makes it sore. You can buy padding for seatbelts that may help reduce this.

Some car insurance policies give specific time limits for not driving after chest surgery. Check with your insurance company.

Getting support

Macmillan is also here to support you. If you would like to talk, you can:

About our information

  • References

    Below is a sample of the sources used in our lung cancer information. If you would like more information about the sources we use, please contact us at  cancerinformationteam@macmillan.org.uk

    National Institute for Health and Care Excellence (NICE). Lung cancer – Diagnosis and management. Clinical guideline 2019.

    Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2018.

    European Society for Medical Oncology (ESMO). Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2017.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

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