Lung Cancer (Bronchial Carcinoma): Surgical Therapy

In bronchial carcinoma, surgical therapy may be indicated depending on the histology (fine tissue findings) and spread of the tumor. This may involve various surgical procedures, including those performed that:

  • Lobectomy* – removal of a lobe of the lung.
  • Segmental resection – removal of a segment of the lung.
  • Pneumonectomy – removal of a lobe of the lung.

* In patients with non-small cell bronchial carcinoma and lobectomy, significantly fewer tumor cells are disseminated to the vasculature when venous ligation is performed first followed by arterial ligation.

Non-Small Cell Lung Cancer (NSCLC):

Stage-adapted therapy of non-small cell lung cancer.

Stage Therapy
Stage I
  • See classification
  • Cure possible by surgery (lobectomy (surgical removal of a lobe of the lung)/resection of the tumor and adjacent lymph nodes). Adjuvant (supportive) chemotherapy is not required after surgery.
  • If necessary, stereotactic ablative radiotherapy (Engl : Stereotactic Body Radiation Therapy, SABR; stereotactic (image-guided millimeter-precise) curative (curative) radiation of the tumor) in patients who can not be operated (eg, because of concomitant diseases, poor lung function):
    • SABR has shown better results than lobectomy in clinical trials for early-stage bronchial carcinoma.
Stage II
  • Stage IIA (T1 (tumor size <3 cm) and involvement of lymph nodes in the lung hilus).
  • Stage IIB (tumor size < 3 cm and involvement of lymph nodes in the pulmonary hilus and mediastinum/mediopharyngeal cavity), and
  • Surgery and adjuvant chemotherapy (therapy that follows surgical rehabilitation).
  • If necessary, stereotactic irradiation of the tumor in patients who cannot undergo surgery (e.g., because of concomitant diseases, poor lung function)
Stage III
  • Tumor involvement of mediastinal lymph nodes, stage IIIA.
  • Stages IIIA to IIIA3 (small or large tumor involving lymph nodes in pulmonary hilus and mediastinum.
  • Postoperative chemotherapy (see below) and adjuvant (supportive) radiotherapy.
  • In the presence of extensive involvement of the mediastinal lymph nodes or infiltration (invasion) of the tumor into surrounding organs (stage IIIA, IIIA4, IIIB), surgery is usually not performed but combined radio/chemotherapy.
Stage IV
  • Metastatic lung carcinoma
  • Patients at this stage are no longer curable. Here, the primary focus is on reducing tumor-related symptoms.

More hints

  • For metastatic non-small cell lung cancer (NSCLC), progression-free survival (PFS) has been shown to be prolonged by consolidative local ablative therapy (koLAT) of all tumor manifestations using (chemo)radiotherapy and/or surgery followed by maintenance therapy.
  • Postoperative chemotherapy (adjuvant chemotherapy) may improve the prognosis of non-small cell lung cancer.
  • The influence of the start of therapy with adjuvant chemotherapy has minimal impact on prognosis. According to one study, the phase between the 40th and 60th day after surgery is associated with the lowest long-term mortality (death rate)

Small Cell Lung Cancer (SCLC)

  • Compared with non-small cell lung cancer, small cell lung cancer grows very rapidly and metastasizes (forms daughter tumors) quickly. Therefore, surgery or radiation therapy alone (radiotherapy) without chemotherapy is not useful.

Further notes

  • One study evaluated patients over 65 years of age with invasive adenocarcinoma or squamous cell carcinoma (diameter ≤ 2 cm) who had undergone limited resection (wedge resection or segmentectomy) or lobectomy.The result showed worse survival rates than lobectomy (surgical removal of a lobe of the lung) for invasive non-small cell lung cancer ≤ 2 cm; for adenocarcinoma, limited resection may be equivalent if performed as a segmentectomy (rather than a wedge resection).