Lung cancer: surgery and treatment options

Two different choices matter in lung cancer surgery: how much lung tissue to remove and how to reach it. A lobectomy removes a lobe of the lung; a sublobar resection removes less than a whole lobe. These are not interchangeable choices for every tumour. The approach is a separate decision: a lobectomy can be performed through open surgery or video-assisted thoracoscopic surgery, called VATS. Uniportal VATS uses one access incision rather than several. A 2019 expert consensus considered it an alternative to standard VATS, while calling for longer follow-up and randomised comparisons before drawing firm conclusions about its wider use.

Lobectomy is a standard treatment for stage I non-small cell lung cancer, but suitability depends on more than age. Important considerations include needing oxygen because of severe lung disease, reduced ability of the lungs to transfer gas into the blood, frailty, and how well you manage everyday activities. A smaller resection is an alternative to discuss in selected early-stage disease, but tumour features matter. In particular, invasion of the lung’s outer lining or spread of cancer cells through air spaces can change the balance between a smaller operation and lobectomy. Evidence about these features should not be applied to all small lung tumours.

A 2025 review examined five-year survival in 8,054 patients across 15 studies of non-small cell lung cancers measuring 3 cm or less with invasion of the lung’s outer lining or spread through air spaces. Overall, smaller resections were associated with worse survival than lobectomy in these groups. However, comparisons limited to segmentectomy, a particular type of smaller resection, did not find statistically significant survival differences. Fourteen of the studies were retrospective, meaning they looked back at earlier treatment rather than randomly assigning it; the findings show associations and do not prove that one operation caused better survival. The total of 8,054 covers the whole review, not each comparison, and a lack of statistical difference does not establish that treatments are equivalent. A separate 2026 review of stage I cancers with spread through air spaces found worse recurrence-free survival after smaller resections but similar overall survival, so the reviews do not give a uniform answer about survival.

Lobectomy carries a risk of complications, including death, and some people have a high enough risk that it may not be suitable. Severe underlying lung disease, frailty and reduced day-to-day function are important parts of that assessment. Cardiopulmonary exercise testing measures how the heart and lungs respond during exercise. A 2026 review linked lower peak oxygen uptake and less efficient breathing during exercise with a greater risk of complications around surgery. These findings can inform an individual risk discussion; they are not a personal prediction of the chance of a complication or death.

Breathing-muscle training is one topic to discuss when preparing for surgery. A 2026 review of 13 studies involving 761 patients undergoing lung cancer surgery examined threshold inspiratory muscle training, which trains the muscles used to breathe in against resistance. Compared with conventional breathing training, it found fewer postoperative lung complications, shorter hospital stays and improvements in breathing strength and walking performance. Its timing analysis supported starting one week before surgery and continuing from the first day after surgery. Discuss whether this approach fits your care plan rather than starting a programme on your own. Chest-drain management is another part of early recovery: a separate 2026 review of 17 studies involving 2,929 patients after anatomical lung resection suggested that digital drainage may shorten drainage time and hospital stay, but differences between studies limited firm conclusions.