The vast majority of patients are smokers.
The treatment with the highest chances of cure and / or long-term survival is surgery. Unfortunately, in 60-70% of people diagnosed with lung cancer the disease is already advanced, with the result that therapeutic weapons are limited, without neglecting the significant development in oncology / radiotherapy with the use of targeted drugs and improvement of radiotherapy techniques.
“For this very reason, large studies have highlighted the role of screening in high-risk patients (mainly smokers over the age of 50) by performing a low-dose CT scan that can detect a malignancy – a malignant lung nodule. at a very early stage “.
What is lobectomy?
Our lungs are made up of parts called lobes. The right lung has 3 lobes and the left 2. The lobectomy is a complex operation and involves the surgical removal of the lobe in which the cancer has been found. This surgery is therapeutic for the treatment of non-small cell lung cancer. At the same time, the lymph nodes of the mediastinum are removed, ie the space between the two lungs. In many cases, when the disease is at a relatively advanced stage, chemotherapy and / or radiotherapy may precede and then lobectomy.
When evaluating patients who are candidates for surgery, a key consideration is spirometry, which will allow us to predict whether a patient may undergo lobectomy. In people with impaired lung function and if the anatomy allows, a resection or wedge resection may be performed to avoid the risk of postoperative respiratory complications. Equally important is a cardiological examination, usually with a cardiac ultrasound.
What is thoracoscopic surgery (vats) and why is it advantageous over conventional thoracotomy?
Thoracoscopy (VATS-Video Assisted Thoracic Surgery) is a minimally invasive technique performed with small holes in the chest wall (usually 1 or 2) and the use of a high definition camera. Special thoracoscopic tools are used to remove the lobe and at the same time the lymph nodes of the mediastinum. Most people with lung cancer can be treated with this technique.
“The benefits are many. Initially the surgical wound is clearly smaller and no rib dilator is used as in conventional thoracotomy. This results in the minimization of pain, which is crucial for the postoperative course. The patient can mobilize immediately, a few hours after surgery, and do the breathing exercises they need, which greatly helps to reduce possible respiratory complications. Blood transfusions are extremely rare as the trauma is smaller and does not require hospitalization in an intensive care unit unless of course there are medical reasons from the general condition of each patient. The average hospital stay after surgery is 3-4 days. “The return to daily life and work is much more immediate”, says the doctor.
In addition, if some patients need complementary chemotherapy, they seem to be able to get it in better physical condition.
The oncological result does not differ compared to the open thoracotomy, although it seems that the lymph node cleansing is advantageous as the surgeon sees from a high definition screen and at magnification so he has a better approach to the anatomical area of ​​the lymph nodes.
Are there any studies that prove the benefit of thoracoscopic surgery?
Thoracoscopic lobectomy has been studied for the last twenty years both in terms of its benefits over thoracotomy and whether it can have the desired oncological results. It is now enshrined in the guidelines of the European Society of Thoracic Surgeons (ESTS), the European Society of Medical Oncology (ESMO) and the American Oncology Society (NCCN-National Comprehensive), as preferred for stage I and II non-small cell lung cancer.
Writes:
Mr. Konstantinos Konstantinidis, MD, MSc, FEBTS, Thoracic Surgeon, Director of the 2nd Thoracic Surgery Clinic / Minimally Invasive Thoracic Surgery Clinic of the Metropolitan General.
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