Cardiovascular and Thoracic Surgery

Lung Cancer Treatment

Treatment: Video-Assisted Thoracoscopic Surgery (VATS)

Patients with clinical stage I or II lung cancer who are medically fit are recommend to be treated by a board certified thoracic surgeon with expertise in lung cancer. A minimally invasive approach to surgery, such as video-assisted thoracic surgery, is preferred over open surgery.

The minimally invasive alternative to open chest surgery greatly reduces patient’s pain, recovery time and risk for infection, because the ribs do not have to be separated, the incisions are smaller and there is less blood loss. Minimally invasive surgery also results in fewer complications.

lung-noComplicationsA study in the Annals of Cardiothoracic Surgery revealed that 90 percent of complete video-assisted thoracic surgeries saw no in-hospital complications. VATS also result in reduced suppression of the immune system and results in a milder inflammation response. VATS provides the lowest mortality rate for lung surgeries.

General thoracic surgeons (GTS) are typically best skilled at VATS and complex sleeve procedure as well as lymph node removal, which is important to survival.

VATS can be undertaken in patients with centrally located tumors without extended invasion of the large pulmonary vessels, chest wall, and pericardium. During this minimally invasive approach, the physician makes tiny incisions in the patient’s chest and inserts a thorascope (a fiber-optic camera) as well as surgical instruments. He/she then uses the images from the computer monitor as a guide during surgery. The surgeon has no need to stress or cut ribs, because all movements are performed at the tip of the instrument, at the point of contact with the cancerous tissue. It may be possible to perform any of the resections (wedge, lobectomy, pneumonectomy) described below.

If you have cancer, the type of resection will be based on the tumor location, size, and type, as well as your overall health and lung function prior to diagnosis. The type of lung resection used will depend on the location and size of your tumor, and also the ability of your remaining lung tissue to compensate for your breathing after surgery. 

Types of Minimally Invasive Surgical Procedures for the Lung
  • Lung resection is the surgical removal of all or part of the lung, because of lung cancer or other lung disease. Surgery can provide a cure in some cancer cases, when the tumor is discovered early. Your physician will recommend one of the following types of resection, depending on your diagnosis.
  • Wedge resection, or segmentectomy. These terms refer to the removal of an area of lung smaller than a lobe, usually the tumor and a small area of healthy lung tissue around it. This is a treatment used for early-stage cancer and sometimes to remove a piece of lung where cancer is suspected but not proven.
  • Lobectomy. In a lobectomy, the surgeon removes a lobe of the lungs. This is the usual operation performed for lung cancer, as this has the best chance of removing all the cancerous tissue and decreasing the chance of cancer coming back.
  • Pneumonectomy is the removal of an entire lung. This option is considered if a tumor is especially large, or in a difficult-to-reach or central position in the lung. Although pneumonectomy can result in significant loss of function, many people live quite well with only one lung
Right Wedge Resection of lung nodule using VATS Lobectomy (2 lobes of lungs removed using VATS) Pneumonectomy (entire lung removed) using VATS - UTMB 2011; click for larger image