Surgery to Treat Lung Carcinoid Tumors

Surgery is the main treatment for lung carcinoid tumors whenever possible. If the tumor hasn’t spread, it can often be cured by surgery alone.

Types of lung surgery

Different operations can be used to treat (and possibly cure) lung carcinoid tumors. 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).

• Pneumonectomy: An entire lung is removed.
• Lobectomy: An entire section (lobe) of a lung is removed.
• Segmentectomy or wedge resection: Part of a lobe is removed.
• Sleeve resection: Part of a large airway is removed. Picture a tumor in a large airway as a stain on a shirt sleeve, about an inch or two above the wrist. This surgery would be like cutting across the sleeve above and below the stain and sewing the cuff back onto the shortened sleeve. When this surgery can be done instead of a pneumonectomy, more lung function can be preserved.

With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.

The type of operation your doctor recommends depends on the size and location of the tumor and on how well your lungs are functioning. People whose lungs are healthier can withstand having more lung tissue removed.

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 slow down. Generally, your time in the hospital after surgery can range from 3 to 7 days depending on the type of surgery that is done.

Lymph node sampling

With any of these operations, lymph nodes near the lungs are usually removed to look for possible spread of the cancer. This is important because the carcinoid might have spread to lymph nodes by the time it is diagnosed. (This risk is higher for atypical carcinoids than for typical carcinoids.) If the lymph nodes containing cancer are not removed, it will increase the risk of the carcinoid tumor spreading even farther, to other organs. If this happens, you may no longer be able to be cured by surgery. Checking for cancer cells in the lymph nodes can also provide some indication of your risk of the cancer come back.

Video-assisted thoracic surgery (VATS)

This is a less invasive type of surgery for some cancers in the lungs. During this operation, a thin, rigid tube with a tiny video camera on the end is placed through a small cut in the side of the chest to help the surgeon see inside the chest. One or two other small cuts are created in the skin, and long instruments are passed though these cuts to do the same operation that would be done using an open approach (thoracotomy). Because only small incisions are needed, there is less pain after the surgery and a shorter hospital stay – usually around 4 to 5 days.

Most experts recommend that only smaller tumors near the outside of the lung be treated this way. The cure rate after this surgery seems to be the same as with surgery done with a larger incision. But it is important that the surgeon doing this operation be experienced because it requires a great deal of technical skill.

Possible risks and side effects of lung surgery

Possible complications depend on the extent of the surgery and the person’s health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia.

Lung surgery is a major operation, and recovering from the operation typically takes weeks to months. If 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. People who have VATS instead of thoracotomy have less pain after surgery and tend to recover more quickly.

If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after a lobe or even an entire lung has been removed. If you also have non-cancerous diseases such as emphysema or chronic bronchitis (which are common among people who smoke heavily), you may become short of breath with activity after surgery.