Surgery

Lung Cancer

What is lung cancer, how to perform a biopsy to diagnose lung cancer and what are the procedures conducted in our cardio-thoracic unit in Kaplan Medical Center?

Lung cancer is the most common death factor, among cancer patients. Cigarette smoke is usually the cause of lung cancer but there are other related factors that increase the chance of lung cancer. Unfortunately, today, we see a rise in lung cancer patients, also among people who never smoked.

When someone develops lung cancer, we conduct extensive tests in order to determine the cancer type and its spread and match the optimal treatment for the disease.

The tumor type depends on the size of the tumor and in whether or not it penetrated to the lymph nodes surrounding the lung or spread to other places in the body. When we have a suspicious for a lung tumor, we assemble a multi-disciplinary team in order to plan a personalized procedure for the patient.

To diagnose, we conduct a chest x-ray and computerized tomography (CT) of the thorax.

In order to determine the tumor type, it is necessary we sample it, by doing a biopsy.

A biopsy can be done in one of few ways:

  • Bronchoscopy is a procedure in which a flexible tube with a camera and other small tools is inserted orally or nasally and then enters the trachea and reaches the lung.
  • CT guided needle biopsy is conducted by locating the tumor with a CT and inserting a thin needle through the skin to take a small tissue sample.
  • Sometimes we have to operate in order to reach a diagnosis. In most cases, the biopsy is integrated with a surgery to cut the tumor.

The common surgical procedures conducted in the thoracic surgeries unit in Kaplan Medical Center are mediastinoscopy – a surgical procedure that allows to examine and sample areas of the Mediastinum – an area behind the sternum and between the lungs.

This procedure is used to identify and sample tumors, infections and many other diseases and also to determine the stage of malignant diseases and to match a treatment for them.

The procedure involves general anesthesia, and is performed by inserting a camera through a small incision above the sternum (at the base of the neck).

The procedure lasts for 45 minutes. After it is over, the incision is sewn, and the intubation is removed.

The admittance length after the procedure is one day.

Thorcoscopy (VATS) – video assisted thoracic surgeries (VATS) is a minimally invasive thoracic procedure, which significantly diminishes the recovery and the patient’s physical and mental trauma. In this approach, we insert a camera to the thoracic cavity, and it makes it possible to perform complex surgeries with small incisions.
The main advantage of this method is to avoid a large incision in the thorax wall and to regain regular activity soon.
After the surgery, we insert a drain through the thorax wall to drain fluids and air. This drain is taken out when you are discharged from the hospital. In cases where we experience technical difficulties, such as severe adhesions, tumor type or its location, we might require a larger incision (thoracotomy) in order to safely complete the surgery.

Wedge resection – when we find suspicious lesions in the patient’s lungs, we have to take them out. Sometimes, the lesion will have to come out with some of the healthy tissue that surrounds it. This procedure is called wedge resection and it is mostly done under general anesthesia using a minimally invasive approach (thoroscopy) which eases the recovery process.
The average admittance length after these surgeries is 3-5 days.

Surgeries for pneumatic chest – pneumatic chest is a situation in which a puncture in the lung cases the accumulation of air around it and pressurizes the lung. Mostly, this situation occurs due to the puncturing of the small alveoli at the top of the lung.
The primary therapy for these cases is usually to insert a drain in order to drain the lung and enable its proper activity. In most cases there is no need of another therapy, but in cases of repeating events, we recommend to refer the patient to surgery in order to prevent additional cases. In surgery, done in a minimally invasive approach (thoroscopy) we dissect the area in which the alveoli are concentrated using a wedge resection and create an adhesion of the lung to the thorax wall to avoid recurrences.
The average admittance length after these surgeries is 3-5 days.

Lobectomy – the lungs are divided to a few sub-divisions called lobes. The accepted treatment for lung cancer today is a lobectomy of the lobe infected with cancer and sampling the lymph nodes around it. The procedure is done under general anesthesia, and it can mostly be completed using a minimally invasive technique (thoroscopy) which eases the recovery.
The average admittance length after these surgeries is 4-8 days.
 
Pneumonectomy – lung tumors, especially central tumors, sometimes oblige the amputation of a complete lung. The surgery is done after a meticulous pre-surgical evaluation, and is done in an “open” approach. In most cases, there is a need for a short admittance to the intensive care unit after the surgery.
The average admittance length after these surgeries is 5-10 days.

Mediastinum surgeries – the mediastinum is an area adjacent to the heart, behind the sternum. Suspicious findings in the Mediastinum oblige amputation. After a meticulous evaluation of the lesion size and its location, we determine the surgical approach, but mostly these can be completed using a minimally invasive approach, which eases the recovery process.