Dr. Jessica Donington, Lysa Buonanno

Learn about the thoracic surgery options for early stage lung cancer patients. Dr. Jessica Donington joins with lung cancer patient and advocate Lysa Buonanno to discuss the various types of surgeries to consider and the difference between thoracotomy and VATS procedures.

What are the surgery options for early stage lung cancer patients?

For stage 1 or 2 disease, the standard is a lobectomy – either one third of the lung on the right or half on the left, with all lymph nodes and blood vessels that go to that lobe removed in order to assure no cancer cells have spread. Minimally invasive techniques such as robot or video-assisted surgery can be used in order to reduce recovery time, pain and risk of complications while remaining just as effective as open operations.

Surgeries for early stage disease is described in two ways:

  1. how much lung is surgically removed by the thoracic surgeon
  2. how the thoracic surgeon get through the chest wall to get there

The standard surgery for patients who have stage 1 or stage 2 diseases is a lobectomy. However, for some patients with very small tumors (less than 2 centimeters), a segmentectomy may be indicated. This procedure is where just a portion of that lobe is removed. But again, removing all the lymph nodes and all the blood vessels that go to that region are removed as to not miss any cancer cells which may have spread.

What is the difference between a thoracotomy and a VATS procedure?

This addresses how the thoracic surgeon gets through the chest wall. A thoracotomy is called open operation. It’s usually an incision that’s about eight to ten inches long. The surgeon will go between the ribs, and put their hands in to do the operation. For decades, this was the main approach for lung cancer surgery.

In the last 20 years, thoracic surgeons have developed a minimally invasive techniques using either a robot or a video camera, with small incisions (one to three centimeters in size) to go in and do the same exact operation. The advantage of the minimally invasive approach is that it hurts less and the recovery is faster. People get back to their normal self so much better without being a worse operation in terms of cancer treatment.