Lung Cancer: Surgery

What Is Lung Cancer Surgery?

The aim of lung cancer surgery is to remove the cancer completely while preserving as much healthy lung tissue as possible. The lung cancer removal surgery may extract a wedge or segment of lung, a full lobe (lobectomy, the most common), or rarely an entire lung (pneumonectomy), depending on the size and location of the cancer and your lung function.

Surgery for lung cancer can be done through open surgery with a larger incision (thoracotomy) or with minimally invasive procedures such as Video-Assisted Thoracoscopic Surgery (VATS) or Robotic-Assisted Thoracic Surgery (RATS) using small incisions.

Lung cancer surgery recovery time varies, though minimally invasive approaches often allow faster recovery and an earlier return to daily activities.

Types of Lung Cancer Surgery

There is a range of surgical options for lung cancer. Some procedures to remove lung cancer include:

Lobectomy

A lobectomy is a surgery to remove one lobe of the lung. It is a common operation for early-stage lung cancer when the cancerous tumour is confined to one part of one lung. The right lung has three lobes, and the left lung has two. In selected cases, the surgeon may recommend a bilobectomy, which removes two neighbouring lobes of the right lung when the tumour involves both lobes.

Sleeve Resection

Another option is a sleeve resection, used when a tumour involves a lobe and part of the main airway connected to that lobe. In this surgery, the surgeon removes the affected lobe and the involved segment of the bronchus, then reconnects the airway to preserve as much healthy lung tissue as possible. This operation is not as common as other types of lung cancer surgery.

Pneumonectomy

A pneumonectomy is surgery to remove an entire lung. It may be recommended when the tumour is too large or too central to be removed safely with a smaller operation. Before surgery, your doctor will arrange lung function and breathing tests to assess whether the surgery is suitable for you. After pneumonectomy, shortness of breath is common and often increases relative to preoperative levels, particularly during strenuous activity; some tasks may require more effort during recovery and beyond.

Wedge Resection

A wedge resection is surgery to remove a small, wedge-shaped piece of lung that contains the tumour, along with a margin of healthy tissue. A wedge resection removes less lung tissue than a segmentectomy or lobectomy and may be used for very small tumours, for diagnosis, or when preserving lung function is important.

Segmentectomy

A segmentectomy is a surgical procedure to remove a single anatomical segment of the lung. It removes a larger, more structured portion than a wedge resection, but less than a lobectomy. Each lung lobe is divided into segments, and the surgeon removes the affected segment along with its airway, artery, and vein. This allows cancer to be removed while preserving more lung tissue in selected patients with early-stage lung cancer.

Removing Lymph Nodes

During lung cancer surgery, the surgeon examines the lung and nearby structures and usually removes or samples nearby lymph nodes in the chest. This is called a lymph node dissection (lymphadenectomy). Lymph nodes are tested to determine whether cancer cells have spread. If cancer cells are found in the lymph nodes, your doctor may recommend other treatments after surgery, such as chemotherapy. In some cases, before surgery, when the tumour is larger or lymph nodes are suspected to be involved, chemotherapy or radiation therapy may be used to shrink the cancer and make it easier to remove.

How Is Lung Cancer Surgery Performed?

There are two common ways for thoracic surgery for lung cancer to remove part of the lung. One approach uses a larger incision to open the chest, called a thoracotomy. The other is minimally invasive and uses smaller incisions and a camera and surgical instruments, such as video-assisted thoracoscopic surgery (VATS) or Robotic-Assisted Thoracic Surgery (RATS). The decision to have surgery depends on the size and location of the tumour, how far the cancer has spread, your overall health and lung function, and the surgeon’s judgement about what will be safest and most effective. Before any thoracic surgery, preoperative assessment and careful risk planning are important to help ensure the procedure is as safe as possible.

Thoracotomy

A thoracotomy is an operation done through a larger cut on the side of the chest. The surgeon divides some chest wall muscles and uses a specialised device to gently spread the ribs to reach the lung. At the end of the operation, the ribs are allowed to return to their normal position and the muscles are repaired as the incision is closed.

Minimally Invasive Options

Lung cancer surgery can be done minimally invasively, through keyhole surgery for lung cancer. Your thoracic surgeon will decide what is safest based on the condition being treated, the planned operation, and your overall health. Neumark surgeons utilise three different types of lung cancer surgery:

Video-Assisted Thoracoscopic Surgery (VATS)

Video-assisted thoracoscopic surgery is a minimally invasive way to perform a lung operation. The surgeon makes one to three small incisions on the side of the chest. A thin tube with a camera, called a thoracoscope, is passed through one cut so the surgeon can see inside the chest. Special instruments are passed through the other cuts to remove the tissue. VATS may be used to remove small, early non-small cell lung cancers in selected patients, as well as for other thoracic procedures.

Uniportal Video-Assisted Thoracoscopic Surgery (U-VATS)

Uniportal VATS, also known as single-port VATS, is a minimally invasive technique used for selected lung and mediastinal operations. The surgeon performs the procedure through a single small incision rather than multiple incisions. For some individuals, this may reduce postoperative pain and facilitate a more rapid recovery. The approach is not appropriate for everyone; consult your surgeon about whether U-VATS is right for you.

Robotic-Assisted Thoracic Surgery (RATS)

Robotic-Assisted Thoracic Surgery is a minimally invasive approach to removing certain lung cancers and mediastinal growths. The surgeon controls robotic instruments from a console. The system helps guide instruments into the chest through small incisions. RATS is not available at all hospitals and is used only when it is appropriate for the condition and planned operation. Neumark surgeons specialise in RATS at Gleneagles and Mt Alvernia hospitals.

Non-Small Cell Lung Cancer Stages & Surgery

Non-small cell lung cancer (NSCLC) is not treated the same way for everyone. Your lung cancer treatment plan depends on the type of cancer, the stage, where the tumour is located, whether lymph nodes are involved, and how well your lungs and body can tolerate treatment. In the early stages, surgery is often the main treatment. In more advanced lung cancer stages, treatment usually involves medicine, radiotherapy, or a combination of both, with surgery reserved for selected situations. The table below gives a simple overview of the most common approaches by stage and how surgery may fit into the plan.

Pre-Surgery Preparation

Before lung cancer surgery, your team will check that the surgery is safe for you and plan the operation carefully. This preparation helps reduce risk factors and supports a smoother recovery.

Your surgeon will arrange a medical work-up. This typically includes a physical examination, lung function tests, blood tests, and imaging. The results show how well your lungs and human body are likely to cope with surgery.

You will also meet the anaesthesia team before surgery. They assess your fitness for general anaesthesia and explain how pain will be managed after the operation. They will talk through the main risks and what to expect during your hospital stay.

Here are steps you can take to prepare for surgery:

• Stop smoking as soon as possible. Quitting smoking at least two weeks before surgery can lower the risk of complications and support healing.
• Tell your doctor about any blood-thinning medicines and any traditional or herbal medications you take. Some need to be stopped before surgery to reduce bleeding risk.
• Stay active, if you can. Regular walking before surgery facilitates resumption of postoperative activity, supporting recovery.

Post-Surgery Care

After lung cancer surgery, your team focuses on helping you breathe well, control pain, and get you moving safely. 

Right after the operation, you will usually have a chest tube. The tube drains air or fluid from the chest to allow the lung to re-expand properly. You will have pain from the surgery, and you will be given medicine to keep you comfortable enough to cough, breathe deeply, and move. Pain medicines can often be adjusted in consultation with your nurse or doctor; good pain control is an important part of recovery.

You will be encouraged to sit, stand, and walk as soon as possible. Early movement helps the lungs expand and reduces the risk of chest infection and blood clots. Your team may also teach you breathing exercises and pulmonary rehabilitation to improve lung function.

Most patients return to their usual level of daily function after some time. However, surgery involves removing lung tissue, which can lead to increased breathlessness during exertion, particularly in individuals with limited preoperative lung reserve. In rare cases, some patients may require supplemental oxygen for a longer period after lung resection. Your doctor will assess your lung function before surgery to estimate this risk and provide clear advice.

After you go home, follow-up matters. You will have outpatient visits with your doctors, and you may have CT scans to monitor recovery and watch for signs of recurrence. This helps your team detect problems early and act quickly if anything changes.

Common Side Effects

Below are common lung cancer surgery side effects you may experience, along with simple ways to cope with them. 

Fatigue

Fatigue is a persistent feeling of tiredness. It may help to rest with short naps, stay lightly active, accept help with daily tasks, and eat well to support your energy. 

Shortness of Breath

Shortness of breath can be caused by cancer, an infection, or treatment, and you should call your physician immediately if you have chest tightness, chest pain, fever, or trouble breathing while using prescribed medicines. 

Throat and Mouth Soreness

Throat and mouth problems can include dry mouth, mouth sores, and pain with swallowing, and it may help to choose soft, moist foods, avoid spicy, greasy or sharp foods, suck on sweets or ice pops, have ice chips around chemotherapy, and rinse with warm salt water or baking soda solution. 

Hair Loss

Hair loss can occur with chemotherapy and some radiation treatments. It may help to use a mild shampoo and low heat, consider a wig, hat, or scarf, and choose a shorter haircut if that feels easier. 

Gastrointestinal Issues

Treatment can cause loss of appetite, nausea, vomiting, diarrhoea, or constipation. It may help to eat small meals, add calorie- and protein-rich foods such as yoghurt or milk, take anti-nausea medicines as prescribed, choose bland foods and ginger or peppermint drinks, drink fluids between meals, avoid hard-to-digest, high-fibre foods during diarrhoea, and use fluids, fibre, and gentle exercise for constipation. 

Skin Reactions

Skin reactions may include rash, dryness, redness, peeling, or pain. It may help to use gentle products such as lanolin or aloe, protect your skin from the sun, and avoid applying creams right before radiation sessions. Consult your physician if a rash or irritation concerns you. 

Infection and Bleeding

Cancer treatment can increase the risk of infection and make bleeding harder to stop, so call your doctor if you suspect an infection or cannot stop bleeding. Wash your hands often; avoid crowds and contact with sick people; keep your mouth clean; avoid handling soil, plants, or animal waste; and use a soft toothbrush and an electric shaver. 

Nervous System Changes

Some chemotherapy medications can cause tingling, numbness, burning, or weakness in the hands and feet and can impair concentration or memory. Protect your hands and feet from heat and sharp objects; use handrails and wear sturdy footwear to prevent falls; take notes and make lists; and engage in simple cognitive exercises such as Sudoku.

Anxiety or Depression

Anxiety or depression may show up as ongoing low mood, loss of interest, uncontrolled worry, irritability, or trouble concentrating. It may help to stay connected with family history and friends, keep moving if you can, practise breathing or relaxation, speak with a counsellor or psychologist, use spiritual support if it helps, and seek urgent help right away if you have thoughts of self-harm.

Lung Cancer Surgery Survival Rate and Life Expectancy

Life expectancy after lung cancer surgery varies depending on the stage of lung cancer, the type of cancer, and individual health factors. For early-stage lung cancer cases, the lung cancer surgery survival rate is generally favourable, with many patients achieving long-term survival. The treatment trajectory varies across patients, and timely treatment, combined with appropriate follow-up care, can significantly affect outcomes. Your thoracic surgeon will discuss your specific prognosis based on your circumstances.

Lung Cancer Surgery Cost

Lung cancer surgery costs vary based on the procedure type, the hospital facility, and individual patient needs. Factors affecting cost include the complexity of the surgery, the length of hospital stay, and the use of minimally invasive techniques. For detailed information about lung cancer surgery costs in Singapore, please contact Neumark Lung and Chest Surgery Centre directly.