Lung cancer surgery is a major operation, and some complications can occur during the procedure or while the body is recovering. Most patients are monitored closely after surgery so that problems can be identified and treated as early as possible.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Knowing what complications can occur does not mean you should expect them. The risk depends on the type and extent of surgery, the surgical approach, your lung function, age, general health and other medical conditions.
If you are preparing for surgery or recovering from an operation, our Lung Cancer Surgery guide provides an overview of the procedures used to treat lung cancer.
Not Every Post-Surgery Symptom Is a Complication
One of the first things to understand is the difference between expected recovery symptoms and a medical complication. After lung surgery, it is common to experience some pain, tiredness, coughing, reduced appetite, weakness or shortness of breath, particularly during the first days and weeks. These symptoms often improve gradually as the body heals.
A complication is a problem that interferes with normal recovery or requires additional medical treatment, monitoring or intervention. For example, some breathlessness after lung surgery may be expected. But breathlessness that suddenly becomes much worse, particularly when accompanied by chest pain or other concerning symptoms, needs prompt assessment.
The Most Common Complications After Lung Cancer Surgery
Several complications are particularly relevant after lung resection. They can range from problems that resolve with monitoring and supportive treatment to complications that require additional procedures.
1. Prolonged Air Leak
An air leak occurs when air continues to escape from the lung into the space around it after surgery. Some air leakage can occur normally after lung resection and may settle as the lung heals. When the leak continues for longer than expected, it is considered a prolonged air leak.
A prolonged air leak can keep the chest tube in place for longer and may extend the hospital stay. Most cases can be managed without another major operation, although some persistent leaks require additional treatment.
2. Pneumonia and Other Chest Infections
After chest surgery, breathing deeply and clearing mucus can become more difficult because of pain, reduced mobility and changes in lung function. This can increase the risk of a chest infection such as pneumonia.
Possible symptoms include fever, increasing cough, worsening breathlessness, chest discomfort or changes in the colour and amount of phlegm. Early mobilisation, breathing exercises, effective pain control and clearing secretions can all form part of postoperative care to reduce respiratory complications.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
3. Abnormal Heart Rhythms
Some patients develop an abnormal heart rhythm after lung surgery, particularly atrial fibrillation. This can cause a rapid or irregular heartbeat and may be accompanied by weakness, dizziness, shortness of breath or a feeling that the heart is racing or fluttering.
It can occur during the early postoperative period and is usually monitored closely. Treatment depends on the rhythm, symptoms and the patient's overall condition.
4. Blood Clots
Major surgery and reduced mobility temporarily increase the risk of developing blood clots. A clot can develop in a deep vein, usually in the leg, causing deep vein thrombosis (DVT). If part of the clot travels to the lungs, it can cause a pulmonary embolism (PE).
Possible warning signs of DVT include swelling, pain, tenderness or warmth in one leg. A pulmonary embolism may cause sudden breathlessness, chest pain, rapid heartbeat, dizziness or coughing, sometimes with blood. Hospitals commonly use measures such as early movement and medication when appropriate to reduce the risk of blood clots after surgery.
5. Bleeding
Bleeding is a potential risk with any major operation, including lung surgery. Some blood in a surgical drain can be expected immediately after an operation. Significant or ongoing bleeding, however, may require additional monitoring, blood transfusion or, in some cases, another procedure to control the source.
6. Lung Collapse or Pneumothorax
A pneumothorax occurs when air collects in the space around the lung and causes part of the lung to collapse. Because lung surgery involves operating directly on the lung and chest cavity, air leaks and changes in lung expansion can occur during recovery.
Chest tubes are often used after surgery to help remove air and fluid and allow the remaining lung to expand. If a pneumothorax develops or persists, the treatment depends on its size and the patient's symptoms.
7. Wound Infection
The surgical incision can occasionally become infected. Signs can include increasing redness, warmth, swelling, pain, pus or other drainage from the wound. Fever may also occur.
Not every change around an incision means infection. However, increasing rather than improving redness, pain or drainage should be reported to the surgical team.
Less Common but More Serious Complications
Some complications are less common but can be serious and require prompt treatment.
Bronchopleural Fistula
A bronchopleural fistula is an abnormal connection between an airway and the pleural space around the lung. It is uncommon but can be a serious complication, particularly after more extensive lung surgery.
It may be associated with persistent air leakage, infection or difficulty with lung healing. Management depends on the location and severity of the problem and may involve bronchoscopy, drainage or further surgery.
Empyema
Empyema occurs when infected fluid or pus collects in the space around the lung. It may develop following an infection or another complication affecting the chest. Treatment can involve antibiotics and drainage, with more extensive treatment sometimes required depending on the situation.
Respiratory Failure
After lung surgery, the remaining lung tissue needs to provide adequate breathing function. In some patients, particularly those with limited lung function or significant underlying lung disease, breathing may become severely impaired.
This can require additional oxygen, intensive monitoring or mechanical breathing support. This is one reason why lung function testing and other assessments are performed before major lung cancer surgery. The surgical team needs to determine whether a patient is likely to tolerate the planned removal of lung tissue.
Why Some People Have a Higher Risk of Complications
Complications do not occur randomly. Certain patient and surgical factors can increase the likelihood of problems after lung resection. Risk may be influenced by:
- Reduced lung function
- Smoking or a history of smoking-related lung disease
- Older age
- Heart disease or other significant medical conditions
- Poor nutritional status
- The amount of lung being removed
- The complexity and duration of the operation
- The surgical approach used
- Previous chest surgery or other factors affecting the anatomy
Does the Type of Lung Surgery Affect the Risk?
Yes. The extent and type of surgery can influence recovery and complication risk. A wedge resection removes a smaller portion of lung than a lobectomy, while a pneumonectomy involves removing an entire lung. More extensive surgery can place greater demands on the body.
The surgical approach also matters. Minimally invasive procedures such as robotic-assisted or video-assisted surgery generally involve smaller incisions than open thoracotomy and may reduce some recovery-related problems, including postoperative pain. However, minimally invasive surgery does not eliminate the risk of complications.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The most appropriate surgical approach depends on the tumour and the operation required rather than simply choosing the least invasive option.
How Are Complications Detected?
After surgery, your healthcare team does not simply wait for symptoms to appear. Patients are monitored for early signs of complications. Depending on the operation and your condition, monitoring may include:
- Oxygen levels and breathing
- Heart rate and rhythm
- Blood pressure and temperature
- Chest-drain output and air leakage
- Blood tests
- Chest X-rays or other imaging when required
- Assessment of pain, mobility and wound healing
What Can You Do to Reduce the Risk?
Not every complication can be prevented, but several parts of postoperative care can support recovery.
Keep moving as advised. Getting out of bed and walking when your medical team says it is safe can help maintain circulation and reduce complications related to prolonged immobility.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Practise your breathing exercises. Deep breathing and other exercises recommended by your care team can help maintain lung expansion and support secretion clearance.
Do not avoid coughing because of the incision. Supporting the surgical area can make coughing more comfortable while helping clear mucus from the lungs.
Follow your pain-management plan. Severe uncontrolled pain can make it difficult to breathe deeply and move effectively.
Follow wound-care instructions. Keeping the surgical area clean and knowing what changes to report can help identify wound problems early.
Follow medication instructions carefully. This is particularly important if you have been prescribed medicines to prevent blood clots or manage another medical condition.
How Long Can Complications Affect Recovery?
There is no single recovery timeline for complications after lung cancer surgery. Some problems resolve with treatment within a few days. Others, such as a prolonged air leak, can keep a chest tube in place and extend the hospital stay. More serious complications may require additional procedures or a longer period of rehabilitation.
A complication does not necessarily mean that the cancer treatment has been unsuccessful. In many cases, it is a temporary medical problem that can be treated while the patient continues recovering from the operation.
The Bottom Line
Complications after lung cancer surgery can include prolonged air leaks, pneumonia, abnormal heart rhythms, blood clots, bleeding, pneumothorax and wound infections. Less common but more serious problems can also occur, particularly after extensive or complex operations.
The risk is different for every patient. Your lung function, general health, the amount of lung removed and the complexity of the operation all influence recovery. Minimally invasive surgery can reduce some recovery-related problems, but no surgical approach completely eliminates complications.
The most useful approach is to know what is expected, understand which changes should be reported and follow the recovery instructions provided by your surgical team. Early recognition matters because many postoperative complications can be managed more effectively when they are identified promptly.
