Lung cancer surgery involves the surgical excision of the cancerous tissue. It is used mainly in non-small cell lung cancer with the intention of curing the patient.

• Surgery is the best treatment option for patients with resectable tumors.
• The feasibility of surgery depends on the stage of lung cancer at the time of diagnosis.
• The surgical procedures for lung cancer include:^[1][2]
  • Wedge resection (removal of part of a lobe)
    • Wedge resection is performed in patients who do not have adequate respiratory reserve.
    • Radioactive iodine brachytherapy at the margins of wedge resection may reduce the recurrence rate to that of lobectomy.
  • Lobectomy (removal of a single lobe of the lung)
    • Lobectomy is the preferred option for patients with adequate respiratory reserve because it reduces the chances of local recurrence.
  • Bi-lobectomy (removal of two lobes)
  • Pneumonectomy (removal of an entire lung)
  • Sleeve resection

• The overall operative mortality rate even after careful patient selection is about 4.4%.^[3]
• The patient selection for lung cancer depends on:
  • The stage
  • Location and cell type
  • Pulmonary reserve
  • Cardiac evaluation

• In non-small cell lung cancer, the following stages are suitable for surgical resection:^[4]
  • Stage IA
  • Stage IB
  • Stage IIA
  • Stage IIB
• Surgical intervention is not recommended for the management of lung cancer patients with the following stages:
  • Stage IIIA
  • Stage IIIB
  • Stage IV

For more information on staging, please visit non-small cell lung cancer staging.

• A sufficient preoperative pulmonary reserve must be present to allow adequate lung function after the tissue is removed.
• Pulmonary reserve is measured by spirometry.
• The preoperative physiologic evaluation established by the American College of Chest Physicians for patients with lung cancer for surgical resection include:^[5][6]
  • Spirometry
  • Measurement of FEV1 and carbon monoxide diffusion capacity (DLCO).
    • The minimum forced vital capacity (FVC) for pneumonectomy in men is 2 liters.
    • The minimum forced vital capacity (FVC) for lobectomy is 1.5 liters.
    • In women, the minimum FVC values for pneumonectomy and lobectomy are 1.75 liters and 1.25 liters, respectively.
• Surgery is contraindicated if spirometry reveals poor respiratory reserve which is often due to underlying chronic obstructive pulmonary disease (COPD).

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