Dr. D. Kutsco, MD; Consultant Surgical Oncologist & CMD
Surgery for small cell Lung Cancer
Surgery is rarely used as part of the main treatment for small cell lung cancer (SCLC), as the cancer has usually already spread by the time it is found.
Occasionally (in fewer than 1 out of 20 patients), the cancer is found as only a single lung tumor, with no spread to lymph nodes or other organs. Surgery may be an option for these early-stage cancers, usually followed by additional treatment ( chemotherapy, often with radiation therapy).
If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done first to see if you would still have enough healthy lung tissue left after surgery. Other tests will check the function of your heart and other organs to be sure you’re healthy enough for surgery.
Because surgery isn’t helpful for more advanced stage lung cancers, your doctor will also want to make sure the cancer hasn’t already spread to the lymph nodes between the lungs. This is often done just before surgery with mediastinoscopy or with some of the other techniques described in Tests for Small Cell Lung Cancer. If cancer cells are in the lymph nodes, then surgery is not likely to be helpful.
Types of lung surgery
Different operations can be used to treat SCLC:
In general, lobectomy is the preferred operation for SCLC if it can be done, because it offers a better chance of removing all of the cancer than segmentectomy or wedge resection.
With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer. These operations require general anesthesia (where you are in a deep sleep) and are usually done through a surgical incision between the ribs in the side of the chest (called a thoracotomy).
When you wake up from surgery, you will have a tube (or tubes) coming out of your chest and attached to a special canister to allow excess fluid and air to drain out. The tube(s) will be removed once the fluid drainage and air leak stop. Most people will spend about a week in the hospital after the surgery.
Possible risks and side effects of lung surgery
Surgery for lung cancer is a major operation and can have serious side effects, which is why surgery isn’t a good idea for everyone. While all surgeries carry some risks, they depend to some degree on the extent of the surgery and a person’s health beforehand.
Possible complications during and soon after surgery can include reactions to anesthesia, excess bleeding, blood clots in the legs or lungs, wound infections, and pneumonia. While it is rare, in some cases people may not survive the surgery.
Recovering from lung cancer surgery typically takes weeks to months. When the surgery is done through a thoracotomy, the surgeon must spread the ribs to get to the lung, so the area near the incision will hurt for some time after surgery. Your activity will be limited for at least a month.
If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after some time if a lobe or even an entire lung has been removed.
If you also have another lung disease such as emphysema or chronic bronchitis (which are common among heavy smokers), you might become short of breath with activity after surgery.