Non-Small Cell Lung Cancer Surgery

In a wedge resection, surgeons remove a wedge of tissue containing an early, very small, or slow-growing non-small cell lung cancer tumor. Early tumors are usually confined to the lining of the airways and have not yet spread to the lung tissue. This procedure may preserve healthy tissue and lung function in people who are having trouble breathing because of the cancer.

Doctors may also remove some area lymph nodes, small immune system glands that trap viruses and bacteria to protect against disease. They are one of the first places cancer spreads. Pathologists examine these lymph nodes under a microscope to ensure that they don’t contain cancer. If they do, additional surgery or other treatments, such as chemotherapy or radiation therapy, may be needed.

In a segmental resection, surgeons remove a segment of a lobe, instead of a wedge. The lungs are divided into sections called lobes by naturally occurring long, narrow openings. There are three lobes in the right lung and two in the left. The lobes are further divided into a number of smaller segments.

During a segmental resection, the doctor may also remove the surrounding lymph nodes to check for cancer cells. Taking out a larger portion of tissue helps surgeons to remove the cancer along with a healthy border, or margin, of tissue. A margin clear of cancer cells helps ensure that the tumor has been completely removed.

The decision for a wedge or a segmental resection may be made during surgery. This may be an option for people who have very small tumors but good lung function and can breathe well.

In a lobectomy, surgeons remove a lobe of the lung that has cancer in it as well as area lymph nodes. The remaining healthy lobes continue to function and help you breathe. A lobectomy may be used to remove relatively small tumors in people with good lung function.

Pneumonectomy is the surgical removal of an entire lung. It’s performed for larger cancers that are centrally located in the lung, or when cancer has spread beyond a single lobe, making a lobectomy ineffective. Your remaining healthy lung continues to function, allowing you to breathe after the procedure.

As with other types of lung surgery, you doctor may also remove area lymph nodes to check for the spread of cancer. That can help determine what further treatment may be needed.

In order to have a pneumonectomy, people need to have good breathing function. If this surgery is recommended, doctors at NYU Langone’s Rusk Rehabilitation can prescribe a lung rehabilitation program to help you recover your strength after surgery and live an active life with one lung.

In a sleeve resection, doctors remove a portion of the bronchus, or airway, if cancer is found there, in addition to the surrounding lung lobe. Surgeons then rejoin the healthy ends of the bronchus together.

Sleeve resection may be used instead of pneumonectomy to help preserve healthy lung tissue in people who do not have good lung function and are having trouble breathing. Doctors may also remove nearby lymph nodes to be examined by a pathologist for the possible spread of cancer.

To remove non-small cell lung cancer, our surgeons may use open surgery or minimally invasive techniques that don’t require large incisions, such as video-assisted thoracic surgery or robotic surgery.

Open Surgery

In open surgery for non-small cell lung cancer, doctors make an incision between the ribs to access the lungs. This approach is called a thoracotomy, and it is usually used for procedures to remove large tumors, such as pneumonectomy and sleeve resection.

Recovery typically takes about 7 to 10 days. During this time, our doctors monitor you and help manage any pain you may be experiencing.

Video-Assisted Thoracic Surgery

Video-assisted thoracic surgery is a minimally invasive approach that may be used to perform operations to remove small non-small cell lung cancers, such as wedge resection, segmental resection, and lobectomy. Perlmutter Cancer Center surgeons helped pioneer this approach and it is the standard of care at NYU Langone.

In this procedure, doctors make several small incisions on the side of the chest between the ribs in the chest wall, through which they insert a thoracoscope, a long, thin, tube with a video camera on the end of it. Doctors can view the lungs, area lymph nodes, and other surrounding tissues on a screen while they insert surgical tools through the scope to perform the operation. They also remove tissue through the small incisions.

Video-assisted thoracic surgery provides doctors with clear images of the lungs and greatly enhances the accuracy and safety of procedures to remove small lung tumors. Because this approach involves small incisions, hospital recovery time may be a few days shorter than for open surgery.

Robotic-Assisted Surgery

At NYU Langone’s Robotic Surgery Center, doctors use an advanced surgical system to perform procedures to remove small lung tumors, including wedge resection, segmental resection, and lobectomy.

The surgical system consists of tiny instruments mounted on robotic arms. One arm contains a camera that generates magnified, three-dimensional images on a computer screen, which help guide the surgeon during the procedure. The surgical instruments and camera are inserted through several small incisions made in the chest wall between the ribs. The surgeon controls the instruments and the camera from a console in the operating room.

Robotic surgery may have several advantages over other surgical approaches. The camera used in the procedure gives doctors an excellent view of the lungs, surrounding lymph nodes, and other area tissues. The range of motion of the robotic arms enhances the surgeon’s ability to perform delicate procedures within the small space of the chest. The approach may result in less bleeding and scarring and a shorter recovery time than open surgery.

A hospital stay after robotic surgery may be a day or two shorter than with video-assisted thoracic surgery.

Sometimes non-small cell lung cancer surgery may cause difficulty breathing, because lung tissue is removed. Surgery can also cause weakness, as well as difficulty walking and performing your usual daily activities. Your doctor may recommend the inpatient pulmonary rehabilitation program at Rusk Rehabilitation if you are not medically and functionally ready to go directly home after your surgery.

After you return home, our doctors at Rusk Rehabilitation’s outpatient pulmonary rehabilitation program can prescribe therapy to help improve your breathing, strength, and physical function so you can continue to participate comfortably in your usual activities.