ENWhen a report says “lung cancer”, patients usually hear two opposite opinions: “operate at once” and “it is too late to operate”. The difference lies not in opinion but in the stage and whether the person would withstand surgery.
This page explains how lung cancer surgery in Germany is decided, which operations are done, what is always checked beforehand and what follows; other treatments are on the general page on lung cancer treatment in Germany.
When the tumour is removed
Surgery is discussed when the tumour is confined to the lung and nearby lymph nodes and can be removed whole, above all in non-small cell lung cancer. Small cell lung cancer behaves differently: it grows fast and has mostly spread beyond the lung when found, so treatment usually does not start with surgery.
The decision depends on the tumour’s size and position, growth into the large vessels and main bronchus, and the state of the mid-chest lymph nodes. This is established before the operation, not during it (see lung cancer diagnosis in Germany), and a board of thoracic surgeons, pulmonologists, oncologists and radiologists decides.
Surgery is ruled out by several nodules in both lungs, distant metastases, growth into structures that cannot be removed, or too little breathing reserve to take out part of a lung safely. Radiotherapy and drug treatment are then offered: not a refusal to help but a different route, continued on the page on chemotherapy for lung cancer. With isolated metastases, the German guideline advises also treating them and the tumour locally, alongside drugs.
Which operations are done
The standard operation is a lobectomy, removing one lobe with its lymph nodes. The lung has lobes, and losing one leaves enough breathing reserve.
A segmentectomy removes only a segment of a lobe; it is chosen for a small tumour at the edge of the lung or a poor breathing reserve. A pneumonectomy, removing the whole lung, is rare and done only when the tumour cannot be removed otherwise. Whatever the extent, the mid-chest lymph nodes are always removed: without them the stage cannot be established.
Surgeons increasingly operate through small ports with video guidance or a robot instead of spreading the ribs, which changes the first days afterwards. The surgeon chooses the approach from the tumour’s position and the patient’s history, not the patient’s preference.
What is checked before the operation
Doctors check the stage and the body’s reserves. Staging means CT of the chest and abdomen, PET-CT to find deposits outside the lung, and the obligatory assessment of the mid-chest lymph nodes, usually by needle sampling through the airways under ultrasound (EBUS). One abnormal node changes the whole plan.
Breathing reserve is measured by spirometry and a gas diffusion test, plus an exercise test where there is doubt; the heart, blood tests, smoking and weight are checked too. German hospitals offer smoking cessation and breathing exercises some weeks before surgery; this is no formality, as it decides how well the operation is tolerated. The German clinical guideline on lung cancer calls quitting before surgery a proven way to reduce complications.
The board also decides whether drug treatment is needed first to shrink the tumour and whether treatment will follow surgery. The plan is put in writing, and the patient gets a copy.
After the operation: the first days and months
The first days bring a drain, a thin tube that removes air and fluid from the chest, pain relief, breathing exercises from the first hours and early walking. The surgeon decides when the drain comes out and discharge follows. Something rarely said in advance: breathlessness on exertion in the first weeks is expected, not a sign that something went wrong.
Then comes the pathology report on the tumour and lymph nodes, which decides whether treatment after surgery is needed, followed by scheduled check-ups and scans and pulmonary rehabilitation with breathing training. Flying after chest surgery must be agreed with the doctor, not decided by the patient.
Where lung cancer is operated on in Germany
These operations belong to thoracic surgery departments, not general surgery. Among AlenMed’s partners is the Agaplesion Frankfurt Diakonie Hospital, whose thoracic surgery clinic is headed by Stephan Trainer. His fields are operations for benign and malignant diseases of the chest in adults and children, surgery of lung metastases and minimally invasive thoracic surgery, and the hospital has a lung cancer centre certified by the German Cancer Society. Another example is Klinikum Stuttgart, whose thoracic surgery clinic is led by Dr Rainer Sätzler.
For the patient, this means the thoracic surgeon, pulmonologist, oncologist and radiologist meet as one board in one institution, so the stage and extent of surgery are settled within days; the final decision and timing come from the hospital.
Frequently asked questions
Can you live without a lobe of the lung?
Yes. The right lung has three lobes and the left two, and the remaining lobes take over breathing. The reserve is tested beforehand, and if it is poor a smaller operation is chosen. Losing a whole lung is harder on the body, so it is avoided where possible.
Can I ask for a robot-assisted operation?
You can ask, but the surgeon decides. Robot-assisted and video-assisted operations are minimally invasive, and the German guideline advises preferring them to open surgery: less pain and fewer complications with the same cancer outcome. If the tumour’s position or earlier illnesses make this unsuitable, an open operation is chosen.
Is it worth quitting smoking a few weeks before surgery?
Yes. The German lung cancer guideline notes that each additional smoke-free week before surgery is linked to a further fall in complication risk. Counselling combined with medicines that ease quitting works best, and smokers with lung cancer should be offered such help.
How AlenMed arranges the operation
AlenMed starts with documents: a disc with the CT and ideally the PET-CT, bronchoscopy and biopsy reports, slides or blocks for review, lung function results if available, discharge letters and the list of medicines. The department replies whether surgery is indicated, whether treatment is needed first and how many days the trip takes; then come a written estimate, a visa invitation, back-to-back appointments and an interpreter in the hospital (see arranging treatment in Germany).
Plan for someone to travel with, spare time between discharge and the flight, continued treatment at home and a translated report. If the tumour started elsewhere and spread to the lung, see the separate page on resection of lung metastases.
This material is for information only and is not an offer. The extent of the operation is decided by the surgeon in person.
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