NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

42 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 The goal of surgery is to remove all the cancer from the body. To do so, the tumor is removed, along with some normal-looking tissue around its rim. The normal-looking tissue is called the surgical margin. Which surgery you will have depends on where the tumor has grown and how well your lungs work. The preferred surgery for most lung cancers is a pneumonectomy or lobectomy. If a sleeve lobectomy and pneumonectomy are options, a sleeve lobectomy is preferred. It saves most of the lung. A segmentectomy or wedge resection may be an option in two conditions. One condition is if a lobectomy would seriously threaten your health. The other condition is if you have a very small tumor that hasn’t likely spread. If you can have either surgery, a segmentectomy is the preferred choice. Classic and newer methods Removal of a lung tumor can sometimes be done with one of two methods. The classic method is thoracotomy. Thoracoscopy, also called VATS, is a newer method. It is also used to do biopsies as described in Part 4. VATS can be done with or without help from a robot (robotic VATS versus conventional VATS). Not enough research has been done to know if the classic or newer methods are better than the other. Before surgery, you will be asked to stop eating, drinking, and taking some medicines for a short period of time. If you smoke, it is important to stop. Smoking can limit treatment results. General anesthesia will be used. With thoracotomy, a large cut is made from the front of the chest to the back passing under the armpit and shoulder blade. The cut is made between the ribs and through the chest wall. The ribs are spread apart with retractors to allow the surgeon to work. Sometimes, a part of the rib is removed. During surgery, the lung with the tumor is deflated and a breathing tube is inserted down the throat to assist the other lung. After surgery, the cut is sewn closed, but chest tubes are left in place for a few days to drain fluid and air. The surgery can take between 2 and 6 hours to complete. You may stay in the hospital for a few days to recover. With thoracoscopy, 3 or 4 small cuts are made between the ribs on the side of the chest. A small camera and surgical tools are inserted through the cuts. Video from the camera is shown on a screen so that the surgeon can clearly see your organs. Tissue is removed through the small cuts rather than a large opening as done for thoracotomy. During surgery, the lung with the tumor is deflated and a breathing tube is inserted down your throat to assist the other lung. After surgery, the cuts are sewn closed, but chest tubes are left in place for a few days to drain fluid and air. The surgery can take between 2 and 3 hours to complete. You may stay in the hospital for a few days to recover. Lymph node surgery During the surgery to remove the tumor, lymph nodes will be removed. These nodes include those that have or may have cancer. Lymph nodes will be removed by systematic lymph node sampling or lymph node dissection. For sampling, some nodes in the lung and some mediastinal lymph nodes are removed. A lymph node dissection removes as many nodes as possible from the lung and mediastinum. To remove nodes, some organs may need to be moved or cut. If the N stage is N0 or N1, both sampling and dissection are options. Lymph node dissection is advised for stage IIIA cancers with N2 lymph nodes. 5 Overview of cancer treatments Surgery

RkJQdWJsaXNoZXIy MTE3MTE1