Lung cancer is the leading cause of cancer deaths in the United States. When lung cancer is diagnosed early a lobectomy or surgical removal of the affected lobe of the lung is currently considered the standard treatment. Researchers at the University of Pittsburgh have recently reported that a lobectomy performed through a less invasive surgical procedure with fewer side effects appears promising when compared to standard surgery.

A thoracotomy is the standard surgical procedure used to perform a lobectomy. A thoracotomy is a very invasive and serious surgery which is associated with significant side effects and often precludes older and more debilitated patients from receiving potentially curative treatment for their cancer. In order to reach the affected lobe, surgeons performing a thoracotomy have to break some of the patient’s ribs and create a long incision through large muscle layers on the patient’s side and back. Following surgery, patients undergoing a thoracotomy must be closely monitored in the hospital for approximately 2 weeks. Chest tubes (tubes placed in the chest which allow excess drainage to be collected outside the body) are needed temporarily and severe long-term pain is often a side effect from the surgery. These problems have led surgeons to develop less invasive surgical techniques to perform a lobectomy.

Recent advances in minimally invasive technology have allowed complex procedures to be performed with the aid of a video camera. A videothoracoscopic procedure has recently been shown to be effective for performing a lobectomy, while decreasing the undesirable side effects caused by a thoracotomy. The procedure works as follows: 4 one-centimeter incisions are made in the patient’s chest. A very small tube that holds a video camera can be inserted through the incisions, creating a live picture of the inside of the patient’s body. This picture is continually displayed on a television screen, so physicians can perform the entire surgery by watching the screen. Before the lobe containing the cancer is removed from the body, the incision through which it will be removed is enlarged to allow its passage with minimal contact.

Researchers from the University of Pittsburgh have recently compared the outcomes of patients undergoing a lobectomy performed by utilizing videothoracoscopic surgery versus a standard thoracotomy. Thirty-one patients with comparable extent of lung cancer had a lobectomy performed by either method. Patients undergoing videothoracoscopic surgery were discharged an average of 5 days earlier from the hospital than the group undergoing a thoracotomy. The group undergoing videothoracoscopic surgery also had significantly less pain and their chest tubes were removed 3 days earlier than the group undergoing a thoracotomy. These results are very encouraging because they appear to decrease the side effects associated with a thoracotomy. However, further clinical trials need to be performed in order to define which patients will benefit from this approach.

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Patients with early stage lung cancer who are eligible for a lobectomy should speak with their physicians about the risks and benefits of videothoracoscopic surgery, or about the participation in a clinical trial further evaluating this treatment option or other promising new treatment strategies. Two sources of information on ongoing clinical trials that can be discussed with a doctor include comprehensive, easy to use services provided by the National Cancer Institute ( cancer.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. ( Clinical Lung Cancer, Vol 2, No 1, pp 56-60, 2000)

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