Surgery for lung cancer / thorax

The left lung has two loves, and the right lung has three. A lobectomy is a surgical removal of the lung lobe which has a tumor. The lymph nodes next to the tumor will be removed as well. We can use an open surgery technique (thoracotomy) or laparoscopic surgery (VATS) or robot-assisted surgery (RATS).

The lung lobes consist of various segments. A segment resection is a surgical procedure to remove one or more of these segments. This procedure can remove certain tumor types in the lung. This type of surgery will usually be laparoscopic (VATS).

A wedge resection is a surgical procedure that remives a part of the lung lobe in the shape of a wedge (a pizza slice). This surgery aims to remove metastases in the lungs. The tissue will be send to a pathologist for analysis. This surgery can be open surgery (thoracotomy), but is usually laparoscopic (VATS). 

Under very specific circumstances patients with mesothelioma can have surgery. Surgery for mesothelioma is not always beneficial. Surgery is only done as part of a trial, for a small number of patients.

if you have an abnormality behind the sternum, like a thymoma (a tumor of the thymus), you may need surgery to remove it. We can remove it with a RATS or sternotomy procedure. Depending on the exact abnormality and its location, your surgeon will decide which option is best for you.

RATS stands for Robot Assisted Thoracic (of Thoracoscopic) Surgery. We use a RATS to remove tumors in the lungs and behind the sternum. A RATS is a laparoscopic (keyhole) surgery, just like a VATS. The only difference is that all operations are done by a robot controlled by your thoracic surgeon, who is seated in a ”cockpit”. The robot gives the surgeon an enlarged and 3D image of the area which allows for great precision. Because the robot is beneficial in certain kinds of surgeries compared to the VATS, the robot is only used if this procedure has an advantage. Recovery time after RATS is usually quicker than after open surgery (thoracotomy or sternotomy). 

A thoracotomy is a surgical procedure which opens the chest to access the chest cavity or lungs. Your surgeon will make an incision between the ribs (on the left or right side). The exact location will depend on the location of your abnormality. 

A sternotomy is a surgical procedure in which your sternum is opened vertically. After making an incision in the skin, your surgeon will saw through the bone of the sternum. This allows your surgeon access to the chest to remove the abnormality. The sternum will be sewn back together using steel wire, allowing it to close. These wires won’t need to be removed and can remain in place indefinitely. 

You will see the following people at the clinic:

• The thoracic surgeon is responsible for your surgical treatment. You can contact him or her if you have questions about the procedure.
• The pulmonologist is involved in treatment of nearly all patients with lung problems. Before and after your surgery your polmonologist is involved in your medical treatment and he or she will arrange follow-up care. Your pulmonologist will also give you chemotherapy or radiation therapy if required.
• The anesthesiologist manages your anesthesia and pain treatment. He or she will ask you about which medicines you take and will let you know which ones you can take before your surgery. If you need to stay at the Intensive Care unit after your surgery for observation, your anesthesiology will be your practicing physician during your stay.
• Clinical nurse specialists thoracic surgery: your primary contact person in the time surrounding your surgery.
• Your consultation with a nurse at the clinic can prepare you for your admission. The nurse will carry out a medical questionnaire, and there will be plenty of time to ask questions, or request additional information.
• The physical therapist can give you instructions on coughing and practice breathing techniques with you. This will help prevent complications like pheumonia after your surgery.

For a proper recovery after surgery, it is important to be in the best health possible. Consider giving up smoking and alcohol, or eat healthy and exercise.

After surgery you will have a surgical wound (on the inside and outside of your body). Research has shown that wound healing is faster if you do not smoke. The risk of pneumonia increases in smokers. It is very important to quit smoking before your surgery to allow yourself the best recovery possible.

The addictive substance nicotine may make it hard to give up smoking. Please consider quitting before your surgery. The nurses at the smoking cessation clinic can offer support. Your physician or nurse can give you more information.

You may have to spend a night at the Intensive Care after the procedure. Your anesthesiologist will oversee your medical treatment and check-ups. He or she will determine when you can go back to the regular ward together with your surgeon. Most patients will have to spend several hours in the recovery room before being brought back to the ward.

The department physician will see you every day to discuss your recovery together with your nurses. You can discuss new agreements during these visits. The department physician will discuss your progress with your practicing physician. Your surgeon will also see you regularly.

Recovering lung functionality is our top priority. Your nurses (and physical therapist, if needed) will give you advice and exercises to improve your breathing and to help you cough up mucus from the airways.

if tissue has been removed during your procedure for analysis, you will receive the results after 5 to 7 weekdays. Your pulmonologist or thoracic surgeon will discuss these results with you at the in or outpatient clinic, depending on where you are in your recovery.  This consultation will involve your results, any potential follow-up care, and your prospects.

The Netherlands Cancer Institute conducts research into the treatment of lung cancer, pleural cancer, tumors behind the sternum, and metastases. Depending on your personal situation, you may be asked to participate in a trial. 

Regular treatment may not be effective enough for you. If you qualify for a more expermental treament, your physician will provide more information.

When you can leave the hospital will depend on the surgery you have had, and the speed of your recovery. We always aim to let you go home as soon as possible, after an average time of 3 to 7 days, depending on your surgery.

You may need more care after leaving the hospital. Please discuss this with your physician and nurses.

Your nurse will have a discharge consultation with you and a loved one, if you wish them to be present. During this consultation we will reflect on your time at the hospital, and prepare you for the time that lies ahead after your hospital stay. We will also plan an appointment for follow-up screenings at the clinic.

Na het ontslag uit het ziekenhuis kunt u uw dagelijkse activiteiten weer geleidelijk uitbreiden tot uw normale niveau. Zorg daarbij voor een dagritme waarbij na activiteiten rustmomenten ingelast zijn. Het is moeilijk aan te geven wanneer u weer helemaal van de ingreep bent hersteld. Dit hangt af van de grootte en de complexiteit van de ingreep, uw conditie en eventuele voor- of nabehandeling.