Treatment of lung cancer often requires a multidisciplinary approach, involving many specialists working together. Such treatment plans can involve surgery, radiation therapy, chemotherapy, and immunotherapy.
Using minimally invasive treatments such as robotic and endoscopic techniques, as well as stereotactic radiosurgery, we aim to reduce patient recovery times and improve outcomes. The thoracic team at Saint John’s Health Center is highly experienced, treating thousands of lung patients each year, developing innovative treatment approaches. In 1992, our thoracic surgeons pioneered the use of minimally invasive, Video-assisted Thoracic Surgery (VATS).
About Lung Cancer Surgery
Minimally invasive robotic surgery has revolutionized the surgical management of lung cancer. Using advanced robotic systems, surgeons can perform highly precise procedures through small incisions, resulting in reduced tissue damage, less postoperative pain, shorter hospital stays, and faster recovery times compared to traditional open surgery. This technology allows for greater dexterity and enhanced visualization, enabling surgeons to remove tumors with utmost precision while preserving healthy lung tissue. Patients undergoing minimally invasive robotic surgery often experience improved quality of life during recovery, as they can return to their normal activities sooner than those who undergo more invasive procedures. Lung operations typcially invovle removal of a portion of the lung or the entire lung is some circumstances, which is the gold standard for treatment of lung cancer.
Types of Lung Cancer Surgery
Wedge resection is a surgical procedure that removes a pie-shaped portion of the lung.
Removal of a segment of the lung is called a segmentectomy. In selected cases, segmentectomy can provided as good a chance for cure as removal of a lobe. There are 10 segments in each lung.
There are 3 lobes in the right lung and 2 in the left lung. Removal one of the lobes lung is the most common operation to treat lung cancer in the hopes of a cure. While lung capacity is reduced overall, patients learn to develop their remaining capacity more effectively because the diseased portion of lung has been removed.
Pneumonectomy is the removal of the entire lung. Surgical approaches are designed to preserve as much of the organ as possible with curative effect. However, extensive disease may require pneumonectomy.
Sleeve resection is the removal of a piece of bronchus while reattaching the remaining part of the bronchus.
Open-chest surgery (Thoracotomy)
For many years, chest surgery was performed through large incisions. Therefore, the ribs are spread open to allow thoracic surgical access. Today, open suergical procedures are less common, as minimally invasive lung cancer surgeries are easier on the patient, require much smaller incisions, and is equally or more effective. Sometimes, major open surgery is required, such as when the tumor is very large.
VATS (Video-Assisted Thoracoscopic Surgery)
Video-Assisted Thoracoscopic Surgery is a minimally invasive procedure for lung cancer treatment that involves the insertion of a small camera and surgical instruments through small incisions in the chest. This is less invasive than open chest surgery which requires spreading the ribs. VATS lobectomy usually involves three small incisions without any spreading of the ribs, although in selected cases we use only 1 incision (Uniport). A camera is used to assist the dissection of sensitive blood vessels and lung structures. The aim of this kind of procedures is less pain and quicker recovery. If chemotherapy is necessary after surgery, patients are in healthier state and can more reliably begin their adjuvant additional therapy.
Currently, smaller and less complicated procedures, such as wedge resections, are usually performed with VATS. At the Saint John’s Cancer Institute, our thoracic surgeons perform over 90% of their lung cancer operations with minimally invasive surgery. Our published research demonstrates how this reduces complications and length of stay in the hospital without compromising the chance of a cure. We pioneered this technique.
RATS (Robot-Assisted Thoracic Surgery)
Robot-Assisted Thoracic Surgery is a minimally invasive lung cancer surgery that allows for greater surgical precision, enhanced visualization for the surgeon, and increased range of motion. The robot acts as a miniaturized extension of the surgeon’s hands, which allows the surgeon to perform complex surgical procedures through smaller incisions.
Segmental/wedge resection and lobectomy are both done with minimally invasive surgical procedures that use small incisions and specialized instruments with video-scopes to guide the surgical process. Many patients come to us after learning they are not candidates for traditional surgery. We are able to provide innovative surgical options that are safe and effective options for lung cancer patients.
Radiation Therapy for Lung Cancer
Radiation therapy is a critical option of lung cancer treatment, especially for patients who might not be eligible for surgery or when surgery is insufficient to control the disease. This approach utilizes high-energy X-rays or other particles to target and destroy cancer cells while minimizing damage to surrounding healthy tissue. Radiation therapy can be used at various stages of lung cancer, either as a standalone treatment or in combination with other therapies.
There are different types of radiation therapy used in lung cancer treatment, each tailored to the patient’s specific needs:
External Beam Radiation Therapy (EBRT)
EBRT is the most common form of radiation therapy for lung cancer. A large machine that is preprogrammed with the treatment plan delivers focused beams of radiation from outside the body specifically targeting the tumor. Advanced techniques such as Intensity-modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT) allow for this precise targeting, minimizing harm to healthy tissues and nearby organs. SBRT, in particular, can deliver higher doses of radiation in fewer sessions, which can be completed within one to five treatments. This makes it especially effective for early-stage lung cancers.
Brachytherapy involves placing a radioactive source directly within or near the cancer site, giving the tumor the prescribed dose of radation from within the body. While less common in lung cancer, brachytherapy can be used in certain cases, such as for tumors that are obstructing airways. It allows for a higher dose of radiation to be delivered to the tumor while the dose is calculated to not exceed the treatment area.
Proton therapy is a specialized form of radiation therapy that uses protons rather than X-rays, so the results are similar. It can be particularly useful in cases where the tumor is located near critical structures, as proton therapy has a unique ability to deposit radiation precisely at the tumor site, reducing damage to healthy tissues.
Chemotherapy uses powerful drugs to destroy rapidly dividing cancer cells throughout the body. While it can have side effects, advancements in chemotherapy regimens have improved their tolerability and effectiveness, enabling patients to better manage treatment-related symptoms and maintain their daily routines.
Chemotherapy is also used after surgery to kill any cancer cells that may remain. It can be used as a standalone treatment or in conjunction with radiation therapy. Chemotherapy may be used before surgery to reduce the tumor’s size which makes is easier to surgically remove. Chemotherapy can also be used to relieve pain and other symptoms.
Immunotherapy is another groundbreaking approach that harnesses the body’s immune system to fight cancer cells. It has shown great promise in treating advanced lung cancers. Immune checkpoint inhibitors, such as PD-1 and PD-L1 inhibitors, block certain signals that cancer cells use to evade immune detection. By doing so, these drugs help the immune system recognize and attack cancer cells more effectively. Immunotherapy can also lead to durable responses and prolonged survival in some patients, such as those with limited treatment options. Its targeted, biological nature often results in fewer severe side effects compared to traditional chemotherapy.
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