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Lung Cancer Surgery

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Posted 8/5/2014

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Dr. Rudy Lackner, thoracic surgeon at The Nebraska Medical Center discusses minimally invasive techniques to treat people with lung cancer. For more information, visit http://www.nebraskamed.com or call 1-800-922-0000.

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The types of minimally invasive surgery we do for lung cancer (in the spectrum here for doing minimally invasive procedures for our biopsies), but we also remove parts of the lung with the scope. We call those either vats or minimally invasive lobectomies. And it’s kind of a newer approach to them taking out parts of the lung, without actually having to make larger incisions into the chest.

Now, the biggest advantages for doing the operations in this matter is that: (1) we don’t have to open the chest, so there’s no cutting of the muscles on the outside part of the chest, nor do we have to cuddle or remove any parts of the ribs. Patients usually wind up with three or four small incisions that are a centimeter or two in size. In general, there are pain controls that wind up being much much better. Hospital stays tend to be shorter and we’re able to get the patients back to a better functional recovery in a quicker fashion.

This certainly allows us to extend the ability to operate on people who have more advanced emphysema or other lung diseases so that we’re able to take out a part of their lung without opening the chest, because they’re able to breathe better after the operation, they have less complications (such as pneumonia), and again are able to go home sooner and then usually they wind up getting back to a better functional recovery.

Correct, the trend for patients who have more advanced stages of lung cancer in general is to receive a combination of chemo therapy and radiation as their initial treatment. Once they’ve completed that therapy and especially if they’ve had a good response, then we’re able to go in surgically and remove a part of the lung that has the tumor and also remove the lymph nodes, which is usually the situation in that case that sometimes can be done as a minimally invasive procedure (more often is done as a more standard open operation), just because of the need to remove all of the lung tissue and lymph nodes that are involved with the cancer, but more and more even those types of operations will be done in a minimally invasive approach.

Nationwide, it’s estimated that only about 10 to maybe 15 percent of all lung cancer operations are done as a minimally invasive approach. Part of that is surgeons are comfortable with the minimal invasive procedures. Some of it has to do with patient’s anatomy and the type of lung cancer, the stage that they have; so all that winds up factoring.

I think as with the next generation cardio thoracic surgeons are trained, there will be a greater familiarity with doing minimally invasive operations, especially in the chest. So I anticipate that as we wind up going forward, more and more of the lung cancer operations will be done as a vats or minimally invasive procedure.

There’s been at least data available for a number of years that doing the operations with a minimally invasive approach especially more of these are properly done with patients whose cancers are detected at an earlier stage that compared to what traditionally has been survival when we’re finding very small lung cancers and we wind up removing them with the scopes. There have been reports with as high as 90 to 95 percent of those patients being cured that from their lung cancer which is in comparison to 15 to 20 percent of all comers. So there clearly appears to be an advantage in terms of certainly small incisions, but (in terms of) survival from their cancers.

I think that in comparison to what we’ve been dealing with over the years and patients with lung cancer and having a higher risk of dying from their disease; anything new that we could introduce that could improve survival, gets the patients home quicker and then also winds up getting them to their other therapies (whether it be chemo therapy or radiation), in certainly encouraging terms of being able to increase survival from this disease.

I’m Dr. Rudy Lackner, a thoracic oncologist at The Nebraska Medical Center.