Surgery of the chest involving the lungs, some of the large blood vessels, sac around the heart (pericardium) and some cardiac procedures require the performance of a thoracotomy. This incision provides the surgeon with safe access to most areas of the chest. In most cases the incision is minimalist, sparing muscle and nerves, meaning that muscles and nerves are not cut or compressed. This provides for a quicker, less painful recovery and a smaller scar. Surgery typically includes a thoracic epidural catheter placed by the anesthesiologist for postoperative comfort. This allows for the patient to breath without the ventilator (breathing machine) immediately following surgery. Dr. Schmetterer also places a pain buster catheter inside the chest at surgery, which further reduces post operative discomfort.
For cases involving removal of a tumor, the procedure includes the complete removal of the tumor and all lymph nodes in order to identify possible cancer spread. Long term survival has been shown to be increased by careful removal of all lymph nodes. This approach results in less pain, a cosmetically pleasing incision and a shorter hospital stay typically 3-4 days. Post-operative restrictions are include no driving or lifting greater than 5 pounds for 4 weeks.
After surgery, Dr. Schmetterer follows his patients closely, with office visits at 3 weeks, then every 3 months for 2 years, every 4 months for the third year, and every 6 months for life. Follow up xrays are obtained and carefully reviewed with each patient to identify any changes which may require further treatment. Dr. Schmetterer works closely and coordinates care with all of the patient’s physicians: pulmonologists, oncologists, and primary care.
Lung cancer is the second most common form of cancer (after skin cancer) in the United States, with more than 250,000 new cases each year. It isalso the leading cause of death from cancer, more than the next three causes of colon, breast and prostate cancers combined. It mostly affects those over 65 years of age, and is slightly more common in women. The odds of getting lung cancer are 1 in 15 for men, 1 in 17 for women. The risk is much higher for smokers.
Two main categories of lung cancer are small cell and non-small cell. Of these, non-small cell lung cancer is the most common, accounting for nearly 90% of cases. It often grows and spreads less rapidly than small cell lung cancer. There are three types of non-small cell lung cancer — squamous cell carcinoma, adenocarcinoma and large cell carcinoma.
Smoking is the biggest single risk factor for lung cancer in general, although non-smokers may also develop small cell lung cancer. Exposure to substances such as asbestos, radon gas, uranium, arsenic, and diesel exhaust are also known to increase the risk of lung cancer. A family history of lung cancer also can be a risk factor.Many lung cancers are identified when patients undergo a chest X-ray or CAT scan for an unrelated reason — a cold, cough, or other respiratory symptoms.
Symptoms of lung cancer include: persistent cough, coughing of blood, shortness of breath, chest soreness, a hoarse voice, and recurring respiratory tract infections such as pneumonia, unusual fatigue, and weight loss. Lung cancer usually begins in one lung. If left untreated, it can spread to lymph nodes or other parts of the chest, including the other lung. Lung cancer can also spread throughout the body to the bones, brain, liver or other organs.
Lung cancer survival is related to the cancer’s stage, which is determined by the size and location of the tumor, whether the cancer has spread to surrounding lymph nodes, and whether it has spread to distant sites. Early identification of lung cancer via Low Dose Screening CT Scan has been shown to be highly effective in identifying early stage lung cancer which has a much better survival compared to more advanced disease. Lung cancer screening is usually covered by insurance and is available locally at a certified center. More information on lung cancer screening can be found here.
With over 30 years in the surgical care of patients with lung cancer, Dr. Schmetterer has developed an approach which combines individualized treatment and evidence based surgical principles to provide the best possible surgical outcome and survival of his patients.
At the time of initial consultation, the patient’s history and all studies are reviewed. Additional studies such as PET/CT scan, pulmonary function testing, and cardiac evaluation are then scheduled. All patients then receive an in depth review of their findings with a detailed explanation of imaging studies, staging and expected risks and outcomes.
Video Assisted Thoracic Surgery (VATS)
VATS is a surgical approach to the chest which typically involves 2 or 3 small (less than 1 inch) incisions. A thoracoscope (surgical camera) is introduced into the chest for visualization. Special instruments are used to treat the problem area without the need for a thoracotomy incision. Surgical time and recovery are improved with this minimally invasive approach. Patients are usually back to full activity after 1 week. Conditions treated in this fashion include:
- Lung biopsy for interstitial lung disease
- Resection of lung cancer
- Pericardial window for drainage of pericardial effusion
- Evaluation of the chest for recurrent pleural effusion (fluid buildup within the chest)
- Removal of various cysts and tumors of the chest or mediastinum
Infections of the Chest - Decortication
Pneumonia is a common condition in which the lungs become infected with a bacteria or virus. Usually the infection resolves with antibiotic treatment alone. In some cases the process worsens, with fluid collecting outside of the lung called a pleural effusion, or if infected, an empyema or abscess. A pulmonologist may attempt to drain the fluid (thoracocentesis), however in the more advanced cases, the fluid becomes trapped and requires a surgical approach.
Often, the pockets of fluid may be removed with a minimally invasive surgical technique called video assisted thoracic surgery (VATS) decortication. In the most advanced case, a muscle sparing thoracotomy is required. Patients typically progress to a full recovery after the fluid is removed and the lung re-expanded.