Surgery for Small Cell Lung Cancer

Doctors at NYU Langone’s Perlmutter Cancer Center rarely recommend surgery for small cell lung cancer because the cancer has often spread by the time it is discovered. However, they may recommend a surgery called lobectomy to remove small tumors that are found in one lung and have not spread.

This surgery is usually followed by radiation therapy or chemotherapy, or a combination of both treatments.

The lungs are divided into sections called lobes. There are three lobes in the right lung and two lobes in the left. During a lobectomy, surgeons remove the entire lobe in which the cancer is found. This lessens the likelihood of the cancer returning and spreading. The remaining healthy lobes continue to function and enable you to breathe.

Doctors may also remove area lymph nodes, small immune system glands that trap foreign invaders such as viruses and bacteria. Many cancers tend to spread to the lymph nodes first.

After surgery, pathologists—doctors who study diseases in a laboratory—examine the tumor and the surrounding tissue, as well as any lymph nodes that are removed, under a microscope. Their findings help determine whether chemotherapy and radiation therapy are necessary.

Surgical Approaches

To perform a lobectomy, surgeons may use open surgery or a one of a variety of minimally invasive procedures.

VIDEO: Surgery for treating lung cancer.

Open Surgery

To perform open surgery, doctors make an incision between the ribs, so the surgeon can get through the muscles and tissues of the chest wall to reach the lungs. This approach is called a thoracotomy. Open surgery may be needed if the chest wall contains scar tissue from any previous surgery.

The hospital recovery time for open lung cancer surgery is usually about 7 to 10 days. During this time, our doctors monitor you and help manage any discomfort you may have.

Video-Assisted Thoracic Surgery

Perlmutter Cancer Center doctors helped develop video-assisted thoracic surgery, a minimally invasive approach used to perform a lobectomy. During this procedure, a doctor makes several small incisions on the side of the chest between the ribs. He or she inserts a thoracoscope, a long, thin tube with a video camera on the end of it, into the chest wall. The doctor can then view a video of the lungs, area lymph nodes, and other surrounding tissues on a computer screen and place surgical tools through the scope to perform the lobectomy. Tissue is removed through the small incisions.

Our doctors helped develop video-assisted thoracic surgery, a minimally invasive approach to treat small cell lung cancer.

Video-assisted thoracic surgery provides doctors with an excellent view of the lungs and greatly enhances the precision of lobectomy. Because this approach involves small incisions, hospital recovery time may be a few days shorter than with open surgery.

Robotic-Assisted Surgery

Doctors at NYU Langone’s Robotic Surgery Center may use an advanced surgical system to perform a lobectomy. Robotic surgery consists of tiny surgical instruments mounted on three robotic arms. An additional arm contains a camera that creates magnified, high-definition, three-dimensional images on a computer screen to guide the surgeon during the procedure.

The surgical instruments and camera are inserted through several small incisions made between the ribs and into the chest wall. The surgeon controls these instruments and the camera from a console located in the operating room.

The camera used in robotic-assisted surgery can give doctors an excellent view of the lungs, surrounding lymph nodes, and other tissues. The range of motion of the robotic surgical instruments enhances the surgeon’s ability to perform the procedure within the small space of the chest.

Robotic-assisted surgery may result in less bleeding and scarring and a shorter recovery than open surgery. The hospital stay after robotic surgery may even be a day or two shorter than with video-assisted thoracic surgery.

Rehabilitation After Surgery

Sometimes 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 daily activities. If you are not ready to go home right after your surgery, your doctor may refer you to the inpatient pulmonary rehabilitation program at NYU Langone’s Rusk Rehabilitation.

After you return home, doctors at our outpatient pulmonary rehabilitation program can prescribe therapy to help improve your breathing, strength, and physical function so you can continue to be active.