For lung cancer surgeries, should there be an imperative to use minimally invasive techniques?
Video-assisted thoracic surgery (VATS) lobectomies have been available to lung cancer surgeons for two decades. Despite the benefits, only 30 to 40 percent of lobectomies in the U.S. are performed using a minimally invasive technique. And yet, compared with open surgery, lobectomies performed by the VATS approach result in a shorter length of hospital stay, fewer adverse events, less cost to the hospital, and better quality of life for the patient.
“The benefits of VATS also include smaller incisions, less pain, less blood loss, less respiratory compromise, and the survival rates are comparable, if not superior. It’s clear from the data that there should be an imperative to using minimally invasive techniques for lung cancer surgeries,” says Scott J. Swanson, MD, director, Minimally Invasive Thoracic Surgery Program at Brigham and Women’s Hospital, chief surgical officer at Dana-Farber/Brigham and Women’s Cancer Center and professor of surgery at Harvard Medical School.
According to Dr. Swanson, pulmonologists, oncologists and all referring doctors should be recommending a VATS lobectomy over a thoracotomy, and thoracic surgeons should incorporate minimally invasive techniques into their practices, if they haven’t already.
“If you want to learn minimally invasive approaches, Brigham and Women’s Hospital offers training. We’ve pioneered the use of minimally invasive video-assisted thoracic surgery for lung cancer patients. We offer courses, fellowships and resident programs, and we travel to hospitals all over the world to give presentations and teach,” says Dr. Swanson.
For smaller tumors, choose segmentectomy over lobectomy
Due to improved screening, lung cancers can now be detected at smaller sizes. Instead of two to four centimeters, tumors can be spotted at approximately one centimeter. With tumors of this size, there’s mounting evidence to suggest that a lobe doesn’t need to be removed.
“A segmentectomy is an excellent option for patients with a tumor less than two centimeters, located in the segment of interest. This approach is less traumatic and preserves more pulmonary function,” says Dr. Swanson.
In addition, if the cancer returns (as is the case with 10 to 30 percent of patients), the additional pulmonary reserve will help patient tolerate further treatments, such as surgery, radiation, chemotherapy, or immunotherapies.
“Also, patients who undergo segmentectomies better tolerate combination therapies, which is important because the field is increasing using combination treatments before or after surgery,” says Dr. Swanson.
A segmentectomy may also be a choice for patients with few treatment options. For example, a patient in their 80s, or an individual with a heart condition, might not be able to tolerate a lobectomy, but they could undergo a segmentectomy, which is less debilitating.
“I believe segmentectomies aren’t recommended more, because surgical practice always lags behind the data, which can take time to accumulate,” says Dr. Swanson. For instance, in the 1970s and ‘80s many breast cancer patients underwent mastectomies until the medical community showed that lumpectomies were just as effective. Once this surgery became a viable option, patients opted for the less radical operation. The same dynamic might be at play with segmentectomies.
“We have been a leader in segmentectomies for several years, and perform roughly 50 to 60 each year. Given our extensive experience, and the fact that we have done quite a bit of research in this area, many doctors and patients turn to us for these operations,” says Dr. Swanson.
Visit the Lung Center to learn VATS approaches to lung cancer surgery
The Lung Center has a team of surgeons who are highly trained in minimally invasive lung cancer techniques and are dedicated to teaching the next generation of thoracic surgeons. They regularly invite surgeons, operating room nurses and physician assistants, from other organizations to Brigham and Women’s to learn innovative procedures.
Referrals and information
To refer a patient for minimally invasive surgery, please call the New Patient Coordinators at (617) 732-5922. Learn more about referring a patient to the Lung Center and our education and training programs.