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.