Wedge resection

What does the surgery involve?

It is usually a keyhole (VATS) operation and takes about one to two hours. During surgery you lie on your side with your arm raised. Up to four small cuts are made, each about 5 cm (2 inches) long. These are used for the instruments and small camera to go into the chest. Special staples are used to cut and seal parts of lung that need to be removed. The piece of lung can be removed through one of the small cuts. The wound is closed withdissolvable stitches. One or Two chest drains are put in at the end of the operation and held in placed with a stitch. These remove any fluid or air from around the lung.

If a part of the operation cannot be done keyhole the operation may need to be changed to the open technique (thoracotomy). Open surgery is done with one longer cut under the shoulder blade between two ribs. The two ribs are parted to get into the chest. One rib may be cut to give more space, ribs are not removed. At the end of surgery the two ribs are held back together with strong stitches. The muscles and skin are also stitched back together.

What are the risks?

The following are risks of segmentectomy wedge resection:

Minor more common risks

Air leaking from the lung into the chest drain for a few days is common after lung surgery. Occasionally this lasts for longer, possibly weeks. A chest drain will need to be in place until this settles, you may be able to go home with the chest drain still in and come back for regular check-ups until the air leak settles.

Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.

Major less common risks

Some people are more short of breath after surgery. Part of your pre-op assessment is assessing your risk of being breathless after surgery. If you already have lung disease there is a higher risk of being breathless, including needing to have oxygen at home.

Shortness of breath may be severe enough to require help from a ventilator machine. This can be with a face mask with you fully awake. It may also be needed via a tube in your windpipe with you under sedation. If you need help breathing via a tube for a long time it may be better to have a temporary tracheostomy. This is a tube put in through the neck which is removed once breathing improves.

A hole may form near the staples (bronchopleural fistula), this is usually only happens with an infection. It causes air to keep coming out of the lung but can be difficult to diagnose.  You may need antibiotics and another operation to fix the hole.

It is rare to die after segmentectomy or wedge resection. Nationally 99 in 100 people are alive one month after surgery and one person dies.

What are the alternatives to surgery?

Having a diagnosis can guide which treatments would be best for you. It can also give you an idea of what to expect from the disease, including symptoms or whether the disease may shorten your life.

If you do not want to have an operation to get a diagnosis other options may include:

• relying on existing tests (such as scans) to judge which disease is most likely
• repeating a previous test
• continuing close observation

Surgery is thought to give the best chance of being free from cancer if you have early stage lung cancer. Radiotherapy may be as good as surgery in very small cancers at the edge of the lung. This is an active area of research, ask your hospital doctor if this applies to you. You can discuss treatment options with your hospital doctors, your lung cancer nurse and your GP. If you do not want surgery or are not well enough to have an operation other options may include:

• radiotherapy
• chemotherapy
• radiofrequency ablation
• palliative care

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.