Preparing for Your Thoracic Surgery | UCLA Health
Lung Cancer Surgery: What Patients Need to Know
Surgery can be an important component of care — and the better prepared you are, the easier your recovery.
By Linda Marsa
Medically Reviewed by Sanjai Sinha, MD
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In 2011, when Rose Vining underwent surgery to remove a malignancy in part of her right lung, her recovery was tougher than she expected.
“I knew it would be invasive, but the pain was so severe when I awoke from the surgery, I thought I was going to die,” recalls the 67-year-old retiree who lives in Grove, Oklahoma. Nor had she anticipated the considerable fatigue she’d experience afterward. “I thought I’d be back to my old life in a couple of months, but it didn’t work out that way.”
When the cancer recurred a year and a half later and she underwent surgery once again, she was much better prepared.
This time, she made sure she had an adequate pain relief plan in place before her surgery, and she made plans to embark on a physical therapy program soon afterward. Both tactics significantly expedited her recovery. “The second surgery was much easier than the first,” she says.
For people diagnosed with early stage lung cancer, “surgery is the gold standard of care” and offers patients the best chance of a cure, says Daniel Raymond, MD, a thoracic surgeon at the Cleveland Clinic in Ohio. But surgery to remove part or all of a lung is a significant operation. “Patients need to walk into it completely prepared,” says Dr. Raymond.
Here’s what you need to know.
Get tested to see if you’re eligible.Lung function tests are done before surgery to determine whether someone is a good candidate for having all or part of a lung removed. Cardiac tests may also be performed if a patient has risk factors that could lead to heart-related complications. Standard pulmonary function tests include spirometry, which measures how much and how well you inhale and exhale, or the DLCO (diffusing capacity of the lungs for carbon monoxide), which determines how much oxygen is transferred from your lungs to your bloodstream.
Get in shape.A review published in August 2013 in theAmerican Journal of Physical Medicine and Rehabilitationexamined the growing body of evidence that “prehab” (think rehab before the fact) can improve oxygen capacity, exercise capacity, and reduce interventions like tracheostomy as well as hospital stays. “Get off the cigarettes, walk every day to build strength and endurance, and take all the medicines you need, like inhalers, to optimize breathing,” says Raymond. “The amount of work the patient puts in before surgery is directly correlated with how well they do afterwards.” See if your hospital offers the STAR Program, an evidence-based, multidisciplinary prehabilitation program for cancer patients.
Research your surgical options.Surgery to remove part of the lung is called a thoracotomy. The different surgical options for thoracotomy depend on the size and stage of the cancer, how far it has spread, and how well a person's lungs are functioning. One approach that has a shorter recovery time than standard surgery is called video-assisted thoracoscopic surgery (VATS). In VATS, the surgeon makes small, half-inch-wide incisions through the ribs, through which a tiny camera and surgical instruments are threaded. Surgeons can then remove sections of the lung through the tiny incisions rather than a single large one.
Know that recovery takes time — and it’s normal.Hospital stays after thoracotomy average four to seven days, depending on the type of surgery you have, but it can take months to fully recover.
You may feel short of breath.Removal of part of the lung can cause shortness of breath, especially in patients whose lungs were impaired from other illnesses, like emphysema. “People are terrified about being on oxygen and going home tethered to a tank,” says Raymond. “But within six weeks, they’re normally off oxygen.” A respiratory therapist can help you work to restore normal function.
You’ll want a pain plan in place.Pain can be intense after lung surgery. Doctors have an arsenal of tools to help ease acute pain, including nerve blocks, epidural catheters, and longer-acting analgesic medications, like opioid patches. Explore the options beforehand, and don’t be afraid to ask your doctor to tinker with the plan if the pain relief isn’t adequate. Be aware that nerves can be damaged during surgery, too. Though it’s usually temporary, in a minority of patients, nerve impairment can persist for more than a year. Patients who undergo VATS are much less likely to have nerve damage, says Raymond.
Don’t plan on being entirely sedentary.Exercise can lessen symptoms, improve quality of life and may even reduce hospital stays and postoperative complications, according to an analysis published in June 2015 in theJournal of Thoracic Oncology. Three weeks after her second surgery, Vining joined an oncology rehab program and ultimately walked a 10K. “Sometimes it’s hard to determine how much you can do when it’s painful, but a physical therapist can help you pick the right exercises,” says Vining.
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