Lung cancer: surgery

Only a small number of those diagnosed with lung cancer have tumours that are suitable for surgery. If a non-small cell lung cancer is small and has not spread it may be possible to operate and remove it. In small cell lung cancer the cancer has usually spread to other parts of the body before being diagnosed so surgery is rarely used. Here people discuss their experience of lobectomy (the removal of a lobe of the lung), pneumonectomy (removal of an entire lung), and extra-pleural pneumonectomy (removal of the lung, all the pleura, the diaphragm and the pericardium).

In some hospitals surgeons can perform a lobectomy using keyhole surgery, also known as video-assisted thoracoscopic surgery (VATS).

Doris recalled how she felt when she woke after video-assisted thoracoscopic surgery (VATS)…

Age at interview 80

Gender Female

Age at diagnosis 80

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Derick had video-assisted thoracoscopic surgery (VATS) during which doctors removed a lobe of his…

Age at interview 70

Gender Male

Age at diagnosis 69

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Before surgery the hospital will send instructions. One man of South Asian decent described the things he took into hospital for his pneumonectomy. He was a vegetarian and was given special permission to take his own food to the ward.

Remembers what he was asked to take into hospital and describes his pneumonectomy.

Age at interview 69

Gender Male

Age at diagnosis 66

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Explains his habitual special diet and says he was allowed to keep food in the fridge while in…

Age at interview 69

Gender Male

Age at diagnosis 66

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On arrival in the ward members of the hospital team, such as the anaesthetist, may ask questions. The doctor explains what is going to happen, and asks for written consent for the operation.

Describes what happened when he had his lobectomy.

Age at interview 55

Gender Male

Age at diagnosis 50

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Patients are not allowed to eat or drink for several hours before surgery. Usually a ‘pre-med’ (a sedative) is given. The patient is then taken to the operating theatre, where the anaesthetist may start a ‘drip’ (intravenous infusion).

Describes what happened in the ward and operating theatre before his lobectomy.

Age at interview 43

Gender Male

Age at diagnosis 43

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The operation is done under a general anaesthetic, but the patient may also have an epidural anaesthetic at the same time This may be kept in place for a while after surgery to prevent post-operative pain. One man described how an epidural combined with a self-operated pump, also known as a patient controlled analgesic device (PCA), stopped all the post-operative pain. He also remembered being given oxygen.

He used an epidural infusion to control the pain after his pneumonectomy.

Age at interview 52

Gender Male

Age at diagnosis 50

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Describes the epidural and morphine pump that he used for pain control after his pneumonectomy.

Age at interview 70

Gender Male

Age at diagnosis 70

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One woman had had an epidural, but due to low blood pressure after her lobectomy it had to be discontinued. She had severe pain in the area where she had the drainage tubes and was given morphine to relieve it.

Her epidural had to be stopped because her blood pressure dropped, which left her in pain.

Age at interview 53

Gender Female

Age at diagnosis 50

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For mesothelioma at an early stage, an extra-pleural pneumonectomy (removal of the lung, all the pleura, the diaphragm and the pericardium), can sometimes be performed. However, so far it remains uncertain whether this surgery helps. Extra pleural pneumonectomy is rarely done in the UK and is no longer considered appropriate by the majority of surgeons and chest physicians for the treatment of mesothelioma.

One man here described his experience of the radical surgery extra-pleural pneumonectomy for mesothelioma. Like other patients, he spent some time in the High Dependency Unit after surgery.

Comments on his extra-pleural pneumonectomy and the time he spent in the high dependency unit…

Age at interview 54

Gender Male

Age at diagnosis 53

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Discusses his pain control and nursing care after his extra-pleural pneumonectomy.

Age at interview 54

Gender Male

Age at diagnosis 53

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After a short time in the High Dependency Area, patients return to the ward with one or two chest drains in place. These are usually removed after a few days. Patients may also have a catheter inserted into the bladder, which is kept there for a day or two until urine can be passed normally.

Describes what it was like to have a drain removed after his lobectomy.

Age at interview 43

Gender Male

Age at diagnosis 43

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Postoperative recovery in the ward includes physiotherapy. Patients are encouraged to cough up phlegm, and are taught to exercise their arms, shoulders and legs.

Recalls that after surgery he was told to bring up as much phlegm as possible.

Age at interview 52

Gender Male

Age at diagnosis 50

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Describes the physiotherapy he had after surgery and shows his scar.

Age at interview 62

Gender Male

Age at diagnosis 59

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Patients are usually allowed home after 5-10 days. The wound heals gradually and the district nurse may remove the clips or stitches. One man, who had surgery in 2002, was happy to show the long scar on his back.

Describes his post-operative recovery at home; the district nurse removed the stitches.

Age at interview 53

Gender Male

Age at diagnosis 51

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Describes the scar from his pneumonectomy and shows it on film.

Age at interview 48

Gender Male

Age at diagnosis 48

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After such major surgery people may take a while to recover, although some reported feeling much better within a week. Three months after his operation one man said that he could do an hour in his garden but then he had to rest. Some people are left with long-term side effects. One man felt that he would never really recover from his operation. (See ‘Side effects of lung cancer surgery’, and for information about Cryosurgery see ‘Cryosurgery and other treatments for lung cancer’).

Describes his recovery and getting back to work after his pneumonectomy.

Age at interview 70

Gender Male

Age at diagnosis 70

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He has not fully recovered from his operation and his activities are limited.

Age at interview 62

Gender Male

Age at diagnosis 59

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