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Lynne Eldridge MD

Can Surgery for Inoperable Lung Cancer Make a Difference?

By January 17, 2013

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This title needs a little explanation. Why would someone have an operation for an inoperable lung cancer? Yet it happens "all the time" - or often anyway - when it comes to lung cancer. I'll try to explain.


The problem is that it's not uncommon to discover a lung cancer is inoperable until the operation is in progress. Though scans are helpful in determining where the tumor is and the extent of spread to lymph nodes, it's not until the actual surgery that doctors know for sure. And sometimes, too often perhaps, it's found that the tumor is too extensive to be removed completely only when surgery has offered the chance to visualize exactly where and how big a cancer is.

So the question becomes, for people who have surgery for inoperable non-small cell lung cancer - that is, for a lung cancer that can't be removed completely by surgery (the term doctors use is unresectable) - is there any survival advantage? In other words, would people who have surgery to remove at least most of their tumor live longer than those who don't have surgery at all?

The answer is sometimes -- depending upon how much of the tumor can be removed.

Researchers compiled the results of studies to date that address this question. Out of 9 studies looking at over 1000 people, 8 of the studies suggested there is a survival advantage. But while surgery seemed to increase survival if there was left-over microscopic disease (cancer that is present but so small it can only be seen under a microscope) or left-over cancer in lymph nodes, if there was instead "macroscopic disease" left over, survival was not improved. By macroscopic disease they mean cancer left over in the lungs after surgery that can be visualized with the naked eye.

I'm sure many of you are saying, "if you can see left-over cancer in the lungs, then why can't it be removed?" There are many reasons that cancer may not be able to be removed at times. It could be "tangled" up with vital structures such as blood vessels or the heart that can't be removed. It might also be that removing the amount of lung tissue necessary to remove a cancer completely would not leave enough lung tissue behind in order to breathe independently.

Further Reading:

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Dall, K., Ford, C., Fisher, R. and J. Dunning. Is there a survival advantage of incomplete resection of non-small-cell lung cancer that is found to be unresectable at thoracotomy?. Interactive Cardiovascular and Thoracic Surgery. 2013 Jan 11. (Epub ahead of print)

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