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Surgery

Lung cancer, like many other cancers, is mainly treated with surgery, chemotherapy, and radiation therapy. The treatments a patient receives depend on the stage of the cancer and the patient’s physical condition. Because lung cancer requires a multi-modality (more than one treatment) approach, the lung cancer team at Johns Hopkins operates as a multidisciplinary unit.

Thoracic surgeons who specialize in surgery for lung cancer are part of that multidisciplinary team, along with medical oncologists, radiation oncologists, pulmonologists, nurse practitioners, and others. These specialists participate in Johns Hopkins’ multidisciplinary clinic, which offers patients and their families the opportunity to meet with the specialists to discuss the diagnosis and create a treatment plan.

Surgery for lung cancer at Johns Hopkins combines the best of everything—experienced, specialized surgeons, advanced technology like robotic and minimally invasive surgery, and multidisciplinary collaboration across disciplines and fields of study.

Thoracic surgeons perform two types of surgery for lung cancer:

Diagnostic surgery

Diagnostic surgical procedures are done to diagnose lung cancer and also to stage the cancer (determine how big the tumor is, where it is, and if it has spread). Those procedures include:

  • Endobronchial ultrasound (EBUS): This type of bronchoscopy uses an ultrasound probe that allows doctors to look at the lung and mediastinum on an ultrasound monitor. The doctor can then take tissue samples from a lung nodule or a lymph node that may look suspicious for cancer. This procedure may be done by a surgeon or an interventional pulmonologist.
  • Mediastinoscopy: This surgical procedure requires general anesthesia. An incision is made in the neck so that a lighted instrument called a mediastinoscope can be inserted to examine the area between the lungs known as the mediastinum. Biopsies of the mediastinal lymph nodes are taken for cancer staging.
  • Wedge resection: This surgery is used to remove a triangular section of tissue, including the nodule or tumor. It’s used both to remove benign nodules and cancerous tumors and the tissue around them. It may be used as a diagnostic procedure to determine if a suspicious nodule is cancerous. A wedge resection removes the smallest possible amount of tissue.

Surgical procedures

Whether the treatment plan includes surgery depends on a number of factors: the patient’s strength (ability to withstand surgery and its after-effects), the cancer stage, and whether the surgery will both extend the patient’s life and give him or her quality of life.

If possible, surgeons will do minimally invasive or robotic surgery, which offers patients quicker recovery and less pain.

Chest wall resection and reconstruction: Resection of the chest wall may be necessary for tumors involving the sternum or the ribs. Reconstruction often requires collaboration between thoracic and reconstructive plastic surgeons.

Lobectomy: In a lobectomy, the surgeon takes the lobe (the right lung has three lobes and the left lung has two) where the cancer is located. If the patient’s respiratory function is not optimal, a segment of the lobe where the cancer is located may be removed instead of the whole lobe to preserve lung function.

Metastasectomy: This type of surgery is used to remove tumors that have metastasized (spread) from other locations. Most cancers can spread to the lung and some of the more common are breast, bladder, colon, prostate, and sarcoma cancers.

Minimally invasive/robotic surgery: This operation provides the same results as a traditional surgery for lung cancer. The big difference is in how the surgery is done. With traditional surgery to remove lung tumors, an incision is made in the chest and the ribs are spread to allow the surgeon to remove the tumor.

With minimally invasive and robotic surgery, a surgeon can make much smaller incisions that allow tools to go inside the chest cavity. In minimally invasive surgery, the surgeon uses a camera to “see” the operation site while manipulating the instruments inside the chest. In robotic surgery, the surgeon also uses a camera but manipulates robotic arms through a computer console.

In both types of surgery, the patient benefits from the less invasive techniques with less pain and faster recovery.

Photodynamic therapy: This type of procedure uses a photosensitizer or photosensitizing agent and a type of light to kill cancer cells. It is an outpatient procedure that is most often done by an interventional pulmonologist. It is used to relieve symptoms for patients with non-small cell lung cancer that obstruct airways or for patients for whom other therapies have not worked.

Pneumonectomy: This type of surgery is used to remove the entire lung on one side. Because it is serious surgery that can have complications, it is only done if the tumor is located in a spot where removing the lung is the only option.

Radiofrequency ablation: This procedure offers an alternative to patients whose physical condition or cancer stage will not tolerate surgery. Using radio waves, an interventional radiologist can essentially “burn” the tumor off.

Segmental resection: When surgeons do a segmental resection, also known as a segmentectomy, they take the whole lung segment out, including the airway that goes to that segment and the blood vessels going in and out in order to remove any nearby lymph nodes. Those lymph nodes can give doctors information about the cancer and provide guidance for the patient’s next stage of treatment.

A segmental resection preserves more lung function than lobectomies and much more than pneumonectomies.

Sleeve resection: When a tumor is centrally located, it may be necessary to take part of the main airway, known as the bronchus. In a sleeve resection, surgeons remove the tumor and the area around it and then reattach the bronchus. This type of surgery may also be called a sleeve lobectomy.

Stenting: In this procedure, a surgeon or interventional pulmonologist inserts a stent to keep an airway open and help the patient breathe better. It is considered a palliative treatment (given to improve a patient’s quality of life) rather than a curative one.

For an appointment and answers to your questions

As a leading treatment center for lung cancer, Johns Hopkins offers its patients personalized care, specialized treatment, and pioneering therapies to extend life.

To make an appointment or if you have questions, call 410-955-LUNG (5864).

 

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