Surgery for lung cancer: Who is best suited? What you need to know before surgery

Author: Zhi Xiuyi, Chief Physician of Beijing Tsinghua Chang Gung Hospital affiliated to Tsinghua University

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Lung cancer is one of the major health challenges worldwide, and surgery, as one of its key treatments, has brought hope to many patients. Today, we will talk about lung cancer surgery, including the types of surgery, the importance of preoperative preparation, and which patients are more suitable for surgical treatment.

When treating lung cancer, the choice of surgical method is quite particular, and it mainly depends on the stage and location of the tumor. Common surgical methods include lobectomy, segmentectomy, pneumonectomy, and wedge resection. The specific surgical method selected depends on the stage and location of the tumor. For very early lesions smaller than one centimeter, partial removal of the lung, such as wedge resection or segmentectomy, can be considered, but this is only suitable for small lesions in specific circumstances. Currently, the standard treatment for early lung cancer is still lobectomy plus lymph node dissection.

Figure 1 Original copyright image, no permission to reprint

Lymph node dissection is an important part of surgery, which means removing not only the tumor itself but also surrounding lymph nodes that may contain cancer cells, including hilar and mediastinal lymph nodes. This process helps prevent cancer recurrence and accurately assess the cancer stage.

In some cases, if the tumor is located near major structures, affecting blood vessels or bronchi, a complete lung removal may be necessary. However, with the development of medical technology, lobectomy has become the standard surgical procedure for treating early-stage lung cancer, unless the tumor is located in a special way or the patient's specific situation requires other measures.

Wedge resection is sometimes done in older patients or those with poor lung function, although it is not usually the first choice. Another special procedure is sleeve bronchial resection, which involves removing the affected lobe and reattaching the remaining lobe.

In addition to the scope of resection, the surgical approach has also undergone innovation. Traditional open surgery has been gradually replaced by minimally invasive surgery, which includes pure small incision surgery, video-assisted thoracic surgery (VATS), and robot-assisted surgery. These minimally invasive surgeries not only reduce trauma, but also shorten the operation time and postoperative recovery time.

Figure 2 Original copyright image, no permission to reprint

Before lung cancer surgery, comprehensive preparation is also important. Patients need to complete two types of examinations: first, clinical staging examinations to determine the tumor stage, and second, routine preoperative examinations for surgery.

Clinical staging tests are designed to understand the spread of the tumor and ensure the accuracy of the treatment plan. This includes but is not limited to bone scans to rule out the possibility of distant metastasis.

Routine preoperative examinations focus on evaluating the patient's cardiopulmonary function, liver and kidney function, blood coagulation function and infectious disease-related indicators to ensure that the patient has the physical condition to undergo surgery.

For patients who smoke, it is recommended to stop smoking at least two weeks before surgery to reduce complications during and after surgery, especially respiratory complications.

For patients with a history of cardiovascular and cerebrovascular diseases, especially the elderly who are taking anticoagulants, they need to stop taking anticoagulants at least one week before surgery to reduce the risk of bleeding during and after surgery.

If the patient has other diseases, it may be necessary to invite relevant specialists for consultation and decide the order of treatment based on the severity of the disease.

In addition, patients need to make certain psychological preparations. Medical staff will educate patients before the operation, explaining the surgical process, precautions, how to cough and expectorate effectively, etc., to reduce the occurrence of postoperative complications.

As for which lung cancer patients are suitable for surgical treatment, they are mainly stage I patients, some stage II patients, and some stage III patients. For stage I patients, surgery is usually the preferred treatment method, and now there is a tendency to use more sophisticated surgical methods, such as segmentectomy, wedge resection, or anatomical compound segmentectomy, to preserve the patient's lung function to the greatest extent. This is because with the extension of people's life expectancy and the use of targeted drugs, more and more patients can survive for more than five years or even longer, and preserving lung function helps to deal with possible secondary primary cancers.

For patients with stage I lung cancer, surgery is usually enough to solve the problem. However, patients with stage II and IIIA need comprehensive treatment, such as chemotherapy, radiotherapy or targeted therapy after surgery. If pathological examination shows that the patient has hilar lymph node metastasis or mediastinal lymph node metastasis, further treatment such as chemotherapy, radiotherapy or targeted therapy is usually required after surgery.