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Thoracic Cancer Surgeries
Thoracic Cancers include lung cancer, esophageal (food pipe) cancer, mediastinal tumours and chest wall tumours.
Though the incidence of lung and esophageal cancers are not as high as breast, oral or colorectal cancers, they have a high mortality rate. Smoking is the most common risk factor for both lung and esophageal malignancies. Around 80-90 % of these 2 cancers are due to smoking – active or passive. In addition, esophageal adenocarcinomas is becoming a disease of the rich, due to central obesity, poor lifestyle leading to increased GERD and Barrett’s esophagus, going on to esophageal carcinoma. Pleural mesotheliomas form a separate group of malignancies of thoracic cavity involving both visceral and parietal pleurae. Delayed presentation is an important factor related to lesser operable patients and poorer prognosis.
Mediastinal tumours include Thymomas, teratomas, Germ cell tumous, neurogenic tumours, lymphomas etc. Most of these tumours are found in the middle age group, with no specific predisposing high risk factors. Some of these require surgery either upfront or post neoadjuvant therapy. These patients usually respond well to therapy, of course also depending on the clinical stage of the disease.
Chest wall tumours are tumours of the bones of the soft tissues of the chest wall. Some are indolent in nature and take years to grow and present themselves. On the other hand, some are known to be aggressive and have spread to other parts of body especially lung at a faster rate. Many of these tumours require removal of a chest wall with margins (Ribs and surrounding muscle and tissues) followed by reconstruction with synthetic or biological materials.
Surgeries for Thoracic cancer require a multidisciplinary team approach and team work including expert anaesthesiologists, surgical team, good nursing staff, physiotherapist, dietician, physician, pulmonologists and a good ICU backup. Importantly for chest wall tumours a good reconstructive surgeon is mandatory for good functional and cosmetic outcome of the patient.
Surgeries for Thoracic cancers include:
Open:
- Lung resection (lobectomy, pneumonectomy, segmental resection)
- Extra pleural pneumonectomy
- Esophagectomy
- Chest wall resection and reconstruction
- Radical pleurectomy
- Mediastinal tumour excision
- Hyperthermic intrathoracic Chemotherapy ( HITHOC)
- Sleeve resections
- Surgery of Tracheobronchial tree.
Minimally Invasive:
- VATS lobectomy
- VATS +/-Laparoscopic Esophagectomy
- VATS mediastinal tumour excision