Lung cancer surgery

Lobectomy removes a lobe of the lung. During the operation, the surgeon separates the blood vessels and airway serving that lobe so it can be removed. Video-assisted thoracoscopic surgery, or VATS, is a way to perform this operation using a camera. The amount of lung removed and the way the surgeon reaches it are different choices: VATS and open surgery can both be used for lobectomy.

Lobectomy is a standard treatment for stage I non-small cell lung cancer. Whether it is suitable depends partly on how well a person can tolerate surgery. Important considerations include needing extra oxygen because of severe lung disease, reduced ability of the lungs to transfer gas into the blood, frailty and difficulty with everyday activities. Age alone is less important than these measures.

Removing less than a whole lobe, called sublobar resection, is another surgical option, but the cancer’s features matter when comparing it with lobectomy. In particular, cancer extending into the lung’s outer covering or spreading through air spaces needs a more specific comparison than early-stage lung cancer as a whole.

For small non-small cell lung cancers with invasive features, removing less lung does not always give the same results as lobectomy. A 2025 analysis combined 15 studies involving 8,054 patients with tumours no larger than 3 cm that had invaded the lung’s outer covering or spread through air spaces. Across the included studies, sublobar resection was associated with worse five-year overall survival than lobectomy in these groups. Overall survival means being alive, whether or not the cancer has returned.

The results were more nuanced for smaller tumours: among patients with invasion of the lung’s outer covering and tumours no larger than 2 cm, no statistically significant difference in five-year survival or survival without recurrence was found. These findings do not prove that the operations are interchangeable, because most of the studies looked back at patients’ records rather than assigning treatment at random.

Lobectomy carries a risk of complications, including death, and that risk is not the same for everyone. Severe lung disease, reduced lung gas transfer, frailty and limited daily activity are important parts of assessing that risk before surgery.

An exercise test that measures how the heart and lungs respond to activity can also help assess risk around the time of lung cancer surgery. Lower oxygen uptake at peak exercise and less efficient breathing were linked to more complications. These tests help assess surgical risk rather than providing a guarantee about recovery.

Training the muscles used to breathe in may help during recovery from lung cancer surgery. In 13 studies involving 761 patients, breathing in against resistance was associated with fewer lung complications, a shorter postoperative hospital stay and better walking-test performance than conventional breathing exercises. Benefits were reported when training began one week before surgery, and starting on the first day after surgery was reported as safe. This is an option to discuss with the surgical team when planning rehabilitation.