Patients have thoracic (Latin for chest) or lung surgery for various reasons including treatment of early and late stage lung cancer, removal of benign (non-malignant) growths, treatment of chest infections including Valley Fever, empyema, and abscess, treatment of fluid build-up outside of the lung (pleural effusions), removal of mediastinal masses, and to biopsy abnormal findings on x-rays or CT scans. Some surgery can be performed by minimally invasive surgical techniques using a thoracoscope (literally a camera in the chest) through one, two, or three tiny incisions. These types of procedures are interchangeably known as VATS (for video assisted thoracoscopic surgery) and minimally invasive surgery.
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Adult Lung Surgery Specialties:
Meet the Doctor: Andrew Goldstein, MD, FACS, Cardiothoracic Surgeon
– Cancer Fighters Thrive interviews Dr. Goldstein. . . . more
Dr. Goldstein frequently uses the Davinci surgical robotic system for precision removal of tumors in the chest, including lung cancer. He is one of the most experienced robotic thoracic surgeons in Phoenix.
Lung Cancer – Early Stage
Many people are surprised to hear that surgery for early stage lung cancer is often the best available treatment with the greatest chances of providing long-term survival. Myths about surgery causing cancer to spread throughout the body are simply that – myths that have been discounted by scientific and clinical study. Although lung cancer can be highly lethal, when detected early, long-term survival is not only possible, but often likely, with surgical removal of a portion of the lung. This is a serious operation but one that we perform regularly with great success.
The hospital stay is usually three to five days for otherwise healthy individuals but can be longer for people with other medical conditions. Most people can tolerate removal of a portion of one lung or, in less common cases, the removal of an entire left or right lung. Information about your daily physical routine, overall medical condition and history, as well as specialized lung function testing can help determine how well each individual can be expected to recover from this type of surgery.
Lung Cancer – Advanced Stage
It is not uncommon for people with advanced cancers, including lung cancer, to develop fluid collection in their chest that pushes the lung aside causing shortness of breath or difficulty breathing. These are known as malignant pleural effusions (non-malignant effusions are extremely common as well and the presence of fluid in your chest certainly does not indicate that you have a cancer in the absence of further evidence). These fluid collections can be removed by a needle after use of a local anesthetic, but they have a tendency to recur causing bothersome, and at times intolerable, breathing difficulties.
A relatively brief surgical procedure, using minimally invasive surgical techniques, can be a highly effective treatment to prevent fluid from returning to any significant degree. This is known as video-assisted thoracoscopic surgery (VATS) with pleurodesis (a term that means the lung is caused to stick to the inside wall of the chest thereby preventing fluid re-accumulation).
The hospital stay is typically two to three days after this procedure but can be longer. Malignant pleural effusions are often seen in patients with a history of cancer of the lung, breast, or ovary, among others. And remember, that if you don’t have a history of cancer but have been told you have a fluid collection in your chest, this alone, does not mean you have cancer.
Valley Fever is caused by a fungal organism common in the Arizona soil (and the soil of the San Fernando Valley in California which is the actual origin of the name). The specific fungus that causes this infection is named coccidiomycosis or cocci (pronounced cox-ee) for short. Most people who have cocci infections never know that they have been infected because the symptoms are usually mild or are mistaken for other common illnesses.
One problem with cocci is that it leaves small scars or nodules in the lungs that cannot be easily distinguished from lung cancer on chest x-ray or CT scans. In Arizona, because of the high rate of benign cocci infections, many people who have lung cancer are mistakenly thought to have benign cocci nodules. On the other hand, many healthy people with cocci nodules found on x-rays are concerned that they may have lung cancer. This is a serious and sometimes very difficult problem to sort through. Individuals with a history of smoking or second-hand smoke exposure, family history of lung cancer, or enlarging nodules on x-ray or CT scan should probably have a needle biopsy (usually an outpatient non-surgical procedure) performed by a radiologist. People without known risk factors can also develop lung cancer and should seek advice for suspicious nodules.
If there is any doubt about the diagnosis, surgical biopsy may be considered. A PET scan, which is another type of radiographic imaging test, may also play a role but should not be relied on solely to make a diagnosis one way or the other. Sometimes, non-cancerous cocci nodules can grow and form cavities that may not respond to antibiotics. This can create other problems that may require surgical resection of the involved portion of lung.