About 30% of lung cancer cases are diagnosed early, enabling surgical removal of the tumor (usually for stage I or II, but in some cases, surgery may be an option for stage III as well). In advanced cases, when cancer has already spread to other parts of the body, radiation therapy is typically used along with chemotherapy.
The type and extent of the surgical procedure will depend on the tumor type, size, and location.
The three main types of surgery are:
- Wedge Resection which involves the removal of a small segment of the lung (not a very common procedure). Indicated in cases when the lung does not function properly.
- Lobectomy – removal of one lobe of the lung.
- Pneumonectomy – removal of the entire lung.
Hundreds of lobectomy procedures are performed in Israel each year. Most of them are related to lung cancer, however in some cases such procedures can also be indicated for other types of pulmonary diseases, chest injuries, or severe infections. If the surgery is performed in the early stages of cancer, the most likely outcome is a complete recovery.
At Cardiovascular Surgery Unit, a lobe of the lung is removed using the thoracoscopic (minimally invasive) technique which does not require the spreading of the ribs.
The method that we use is called Video Assisted Thoracoscopic Surgery (VATS). This minimally invasive surgery lasts 2-3 hours and is performed on the side of the chest. The surgeon makes three incisions, through which the camera and surgical instruments are inserted. The surgeon identifies the affected lobe of the lung, ligates the feeder vessels and removes the lobe from the patient’s body. Along with the affected lobe, the surgeon also removes the surrounding lymph nodes to evaluate for possible metastases. In some cases, express biopsy is performed as well, to assess whether the tumor has been removed completely, and provide information on the type of cancer.
It should be pointed out that open surgeries are technically easier to perform; however, multiple studies have shown that severe pain experienced by the patient during and after the surgery may actually lead to a reduction in success rates. This is why most lung resection procedures are performed at Tel Aviv Sourasky Medical Center using a minimally invasive technique, “through the keyhole,” while the open surgery technique is reserved for the cases where there is no other option.