Minimally Invasive Lung Cancer Treatment

Dr. Mahtabifard shares the many advantages to having minimally invasive lung cancer surgery over the traditional procedure. Dr. Mahtabifard is a thoracic surgeon at Saint John’s Health Center.

Traditional Versus Minimally Invasive Lung Cancer Surgery

There are a number of reasons surgery is performed on the lungs. The most common reason involves cancer. If a mass is identified within the lung tissue, a surgical team will be assigned to remove it. There are a few approaches that can be taken depending on where the mass is located as well as its size. Surgery may also be performed to correct a collapsed lung or to drain fluid that is accumulating nearby.

Today, minimally invasive techniques are used to reduce the likelihood of complications and provide a shorter recovery period for the patient. In this article, we’ll provide an overview of the differences between traditional thoracotomy and minimally invasive lung cancer surgery. While the former is still performed in some circumstances, the latter is becoming increasingly common.

Types Of Surgical Procedures

First, it’s worth reviewing the different operations performed on the lungs. As noted, most surgical procedures are done to cure lung cancer (LC). If the aforementioned mass is small and only found within a tiny portion of tissue, a wedge resection is performed to remove that portion.

In cases where the cancerous cells are detected within a larger portion of tissue, a lobectomy may be done. This is a procedure during which one entire lobe is removed. If it is necessary to remove two adjoining lobes, the procedure is called a bilobectomy.

When the diseased cells have spread throughout the lung, a surgeon will perform a pneumonectomy to remove the entire organ. Its absence will lower the patient’s quality of life, but the patient can live with only one lung.

Minimally Invasive Approaches

Traditionally, lung cancer surgery was performed through an open chest operation (i.e. thoracotomy). A long incision is made into the patient’s side between the ribs. The surgeon then uses a retractor to spread the patient’s ribs in order to provide enough room to work. With the ribs spread apart, the surgeon accesses the site and removes the tumor.

Thoracoscopy can accomplish the same results without the need to make a long incision or spread the ribs. Instead, the surgeon will make several smaller incisions. A thin, tubular instrument called a thoracoscope is outfitted with a video camera and inserted through one of the small incisions. As the surgeon guides the thoracoscope to the affected tissue, the video camera transmits images of the chest cavity back to the surgical team.

Once the site has been identified, other instruments are inserted and guided to the diseased tissue. The portion containing the cancerous cells is cut away and removed.

Differences Between Traditional and Minimally Invasive Surgery

Because thoracotomy is so invasive, patients are exposed to several potential complications. These can include respiratory failure, internal bleeding, pneumonia, and air leaks. Moreover, the patient is forced to cope with intense postoperative pain during recovery.

With minimally invasive lung cancer surgery, the potential for complications is significantly reduced. There is also far less postoperative pain and the recovery period is shortened. It’s not uncommon for patients to be released from the hospital after two or three days following surgery (compared to up to ten days following thoracotomy).

What To Expect After The Operation

After you undergo lung cancer surgery (assuming minimally invasive techniques are used), you will experience some level of tenderness near the incisions. The pain will eventually subside. Within a few days, you will be released to complete your recovery at home. Your doctor will prescribe pain medications to reduce any lingering discomfort. Once you no longer need these medications, you will be able to resume your normal activities. Most patients find they can return to their normal routine after four or five weeks.

Not everyone is a candidate for minimally invasive lung cancer surgery. Your doctor will want to perform a few tests to check whether this form of treatment is appropriate given the staging of the disease and your condition.

Find the right doctor for lung cancer treatments or mitral valve repair. Early diagnosis can lead to successful results.

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Lung Cancer Surgery Options

Lung cancer may be treated by a variety of therapies which are frequently used in combination to provide an optimal outcome for the patient. Surgical resection is the process by which the tumor is surgically removed, and this is usually recommended when the cancer has not metastasized (or spread) beyond the lung into other parts of the body.

There are several options for performing a resection which may involve minimally invasive surgery or a full operation. Which technique is used will depend on a variety of factors, notably the size and stage of the cancer and whether the tumor can be accessed by the surgeon.

A thoracotomy is performed by the surgeon making an incision through the chest wall and a median sternotomy is performed by entering the chest cavity through the breastbone. Both of these methods are commonly employed in lung cancer surgery but they do involve considerable patient discomfort and extended stays in hospital with a longer recovery period.

Alternative surgical procedures include an anterior limited thoracotomy (ALT) which involves a small incision to allow entry, again through the front of the chest. It should be stressed that the incision is considerably smaller than in a standard thoracotomy or median sternotomy. An alternative is the anterior axillary thoracotomy (AAT) which involves a small incision on the chest front but near the underarm and finally, there is the postero-lateral thoracotomy (PLT) which involves an incision the back or side of the of the patient’s trunk.

Even with these improved surgical techniques, a patient will experience considerable pain if the operation involves opening the chest (sometimes referred to amongst doctors as “chest cracking”).

As a consequence of the extended recovery times and patient discomfort, surgical techniques have been developed which do not involve full-blown surgery – these are the so-called, minimally-invasive techniques.

Video-assisted thoracoscopy (VAT) uses a high powered video camera and hi-definition screen combined with diagnostic scans, such as CT or PET scan, to target the tumors in the patient’s lung. The incision required is much smaller and there is no need to open the chest cavity which results in much less discomfort for the patient and greatly reduced recovery periods. Using the video display, the surgeon is able to resect the tumors which have been identified during the diagnosis and staging phases.

Some doctors do caution the use of VAT however, as a traditional thoracotomy may reveal tumors and other metastasized cancers which have not been discovered in the initial scans and diagnosis. If these remain undiscovered the cancer can return and the patient will become ill again and for this reason, VAT is usually recommended for early stage (I & II) cancers and which have not spread to other parts for the lungs and body.

It is quite usual for any surgical procedure to be accompanied by a phase of chemotherapy or radiation treatment to ensure that the patient’s cancer has been completely removed or killed off. How the treatment proceeds and at what stage a particular therapy will be recommended will be determined by the type and stage of lung cancer a patient has got.

Find the right doctor for lung cancer surgery or mitral valve disease. Early diagnosis can lead to successful results.

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Summary of Treatment Paths For Lung Cancer

When lung cancer (LC) develops, it is critical to diagnose it while the disease is still in its early stages. As it progresses from Stage I to Stage IV, the available treatment options become limited. What’s more, the chances of treating it successfully diminish. In Stage I, the cancerous cells are still localized to the original site. During Stages II and III, they have begun to spread to other areas of the chest. By Stage IV, the disease has spread to other sites throughout the body.

In this article, we’ll describe the three main forms of treatment: surgery, chemotherapy, and radiation therapy. Sometimes, one path is sufficient for removing the diseased tissue. Other times, all three paths are chosen to help prevent a recurrence of cancerous cells.

Surgical Options

If the cancerous cells are still localized, the diseased tissue can be surgically removed. In the event that the disease has spread to other areas of the lung, surgery is still an option. However, because it has spread, removing the affected tissue may not cure the affliction. It can recur. This is a case in which in doctors will often recommend a multi-pronged approach involving chemotherapy, radiation therapy, or both.

In the past, surgery was performed by opening the chest, cutting through the sternum, and spreading the ribs to gain access to the site. Today, minimally invasive techniques using computer-controlled robotic arms can perform the procedure with more precision and less trauma.

Chemotherapy Medications

Because many cases of LC are diagnosed after the cancer has spread to other areas of the patient’s body, chemotherapy is a common treatment path. It is estimated that 50% of those diagnosed with the disease die within four months if they do not receive chemotherapeutic drugs. The drugs can be taken in pill format or injected directly into the patient’s bloodstream.

The purpose of these medications is to systemically kill cancerous cells. The drawback is that they are not discriminatory; these medications will kill both normal and abnormal cells, triggering a host of side effects. Vomiting, blood clots, hair loss, and diarrhea are common, though they disappear once treatment ends.

Radiation Therapy

Radiation therapy is used for the same purpose as chemotherapeutic drugs. In this case, high-energy beams are used to kill the cancerous cells. If a tumor is localized, the radiation can be delivered externally by placing a machine next to the patient near the affected site. It can also be delivered internally by positioning a small contained device inside the patient’s body near the tumor.

The importance of diagnosing lung cancer in its early stages cannot be overstated. By the time the disease has metastasized throughout the body, it is almost impossible to treat it successfully. At that point, chemotherapy and radiation therapy are used to control the symptoms. If lung cancer can be diagnosed early enough, surgery can still be performed to eliminate it.

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Surgical Options in the Treatment of Lung Cancer

Patients who have been diagnosed with lung cancer have a number of treatment options available depending on the type and stage of the disease. Options include chemotherapy, radiation treatment and of course, surgical intervention. It is usual for patients to receive all three treatment regimes as part of their oncology therapy.

Surgery is indicated when in the early stages of the disease as the tumor is confined to a relatively small area and has not spread t other parts of the body. The removal of the tumor is known as a “resection” or you may hear the tumor as being “resectable”. In later stages of the disease, surgery is not usually as beneficial as chemotherapy or radiation treatment in tackling the disease, though “palliative surgery” may be advisable to provide relief for end-stage (Stage IV) lung cancer.

Surgery is not likely to be beneficial in treating the disease when it has spread to the lungs from another part of the body (referred to as “metastasized”), unless the cancer is non-aggressive and the tumor is not large.

Where surgery may be beneficial in curing the disease there are two types of surgical intervention which may take place:

Minimally invasive surgery; and

Traditional open surgery

Minimally Invasive Surgery

This involves the surgeon making two small incisions between the ribs. Each of the incisions are typically an inch or so, but this provides enough room for a skilled surgeon to operate without the need for rib spreading.

In the upper incision, a camera is inserted which relays a high-definition television picture which is used to guide the surgeon as they operate through the second lower incision. This type of surgery is also sometimes referred to as Video Assisted Thoracic Surgery or VATS.

VATS has several advantages for patients whose lung cancer is susceptible to treatment using this technique. There are fewer complications that can arise, while the recovery time and stay in hospital are significantly reduced and the patient experiences much less pain due to the ribs not being spread. Minimally invasive surgery allows patients with early stage lung cancer to return to enjoying a high quality standard of life. Where chemotherapy is required after the operation, the length of treatment is reduced and stands a greater chance of success because it may be initiated much sooner than the alternatives.

Typically, a patient is able to stand up and walk around within two hours of surgery and is usually released from hospital within a day or two.

Traditional Open Chest Surgery

Patients may not be a suitable candidate for minimally invasive surgery, usually associated with anatomical reasons or location of the tumor and stage of the disease. Traditional open surgery involves an incision in the patient’s side and the spreading of the ribs to provide the surgeon with access to the tumor.

Palliative Surgery

Palliative surgery is used to make a patient more comfortable during the end-stages of the disease when the condition has become incurable. For instance, the tumor may need to be removed because it is causing an obstruction of the airway.

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