Thoracic surgery, or surgery on the lungs, is most commonly used to remove lung cancer or to reduce the volume of the lung. If your doctor is considering you as a candidate for Thoracic Surgery, there are a few things that they will want to evaluate. Being that lung cancer is the most common cancer, many individuals diagnosed with this disorder may be possible candidates for Thoracic surgery.

Preoperative evaluations are essential in determining whether a patient is an ideal candidate for surgery or not. There are two main functions of preoperative evaluations. First, to determine the risk and the level of infection with the operation, and second, to make note of patient conditions that need treatment to prevent additional infection or death.

Preoperative evaluations usually begin with a physical examination that goes over the patient’s medical history. Your doctor will want to determine if you have any conditions or predispositions to any conditions that may require you to have additional care before, during, or after the surgery. Things  such as a previous diagnosis of cardiopulmonary disease, diabetes, renal and liver dysfunction, current medications and allergies, and tobacco and/or alcohol use require additional investigation before surgery.

The physical examination will look at the overall health of the patient, however will mainly be focused on pulmonary and cardiovascular areas. A pulmonary exam will be performed and will evaluate respiratory rate, use of accessory respiratory muscles, and presence of wheezing. The cardiovascular examination will document heart murmurs, arrhythmias, and presence of peripheral edema.

Some doctors may even choose to do a Bronchoscopy and Mediastinoscopy. A bronchoscopy is a small scope that goes through your mouth or nose and focuses on the main airways in your lungs. Your doctor may also choose to take small samples of this tissue depending on your surgical plan. A Mediastinoscopy is a small scope inserted in your upper chest that looks at the mediastinum. Your mediastinum contains your heart, thymus, esophagus, trachea, large blood vessels, and various lymph nodes. These tests help prepare your surgeon in developing a surgical plan that is suited to your various needs.

In the case of lung cancer, once verifying the patient is physically able to undergo surgery, the next step is to determine if the neoplasm, or abnormal growth of tissue, is operable. Thoracic surgery is normally recommended for patients with up to stage IIIA tumor. Whether or not the tumor is operable will depend on the neoplasm’s resectability, or the ability to completely remove the growth. Using both chest X-rays and CT scan images, the surgeon will determine if the tumor can be completely removed or not.

In the case of lung volume reduction surgery, the doctor will ascertain what parts of the lung have undergone irreversible damage and must be removed. This surgery is most commonly performed on patients suffering from Emphysema or COPD. By removing the damaged portions of the lungs, it allows the healthy part of the lung to expand and replace the damaged tissue.

Preoperative evaluations are a great way to determine if you are a candidate for Thoracic surgery. By evaluating various factors before surgery, you and your surgeon can determine the right plan for your individual needs. Preoperative evaluations help to assure your surgery is effective and your recovery is swift.

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About the Authors

Dr. Robert McKenna

Robert McKenna, M.D., is the Professor of Surgery, and Director of the Minimally Invasive Chest Surgery and Thoracic Surgical Oncology Center at the Saint John’s Cancer Institute. Dr. Robert McKenna is an internationally renowned thoracic surgeon, who has dedicated over 2 decades in General Thoracic surgery research and clinical care. Learn More About Dr. Robert McKenna.

Osita, M.D., MBA Onugha,

Osita Onugha, M.D., MBA, is the Assistant Professor of Minimally Invasive Chest Surgery and Thoracic Surgical Oncology at the Saint John’s Cancer Institute. Dr. Onugha is a board-certified surgeon and assistant professor of thoracic surgery at the Saint John’s Cancer Institute. Dr. Onugha practices all aspects of thoracic surgery, including procedures for benign and malignant conditions of the lung, esophagus and mediastinum. Learn More About Dr. Osita Onugha.