Understanding different types of lung surgery – keyhole surgery, open surgery, lobectomy
When cancer is detected in the lungs, a positron emission tomography-computerised tomography (PET-CT) scan will help to determine the size of the tumour, the stage of the cancer and the extent of spread into lymph nodes or other areas of the body, if any.
Treatment options for lung cancer include surgery, radiotherapy, chemotherapy, or a combination of these procedures.
For early stage non-small cell lung cancer (NSCLC), surgery is often recommended to secure a better chance for cure.
NSCLC is a more common form of lung cancer compared to small cell lung cancer (SCLC). While SCLC makes up only about 10-15% of all lung cancers, it is relatively more aggressive, growing quickly and spreading early to other parts of the body.
For cancer beyond Stage 2, the patient may undergo chemotherapy to downstage the cancer first before surgery is performed.
Keyhole surgery, which involves small cuts made at the side of the patient’s chest, is a possible option for Stage 1 NSCLC.
There are various advantages to doing keyhole lung surgery – the procedure creates less trauma to the lung and hence, brings about faster recovery with a shorter hospital stay.
Still, these considerations would not take precedence over the overriding objective of ensuring that the cancer is effectively removed from the lung.
The lung is made up of five lobes, or sections. There are two lobes on the left and three on the right.
For NSCLC Stage 1 or 2 lung cancer, surgery to remove the diseased part of the lung involves removing the entire lobe of the diseased lung, via a procedure known as a lobectomy. The surgeon will also remove relevant lymph nodes to ensure tumour clearance when performing a lobectomy.
Open lobectomy (thoracotomy)
An open lobectomy involves long incisions made at the side of the chest to remove the diseased lobe of the lung and lymph nodes. Open lobectomy is also a treatment option in early stage cancer, but will entail more pain and longer hospitalisation compared to a keyhole surgery. Patients with Stage 3 lung cancer will often need chemotherapy first. They will proceed with a lobectomy if the cancer responds well to chemotherapy.
This article has been fact-checked by Dr Lim Chong Hee, consultant cardiothoracic surgeon at Surgi-TEN Specialists, Farrer Park Hospital.