LUNG NODULES/LUNG CANCER

Lung cancer is the leading cause of cancer death in both men and women in the United States. Patients with early stage tumors have a high likelihood of cure. Many of these patients are candidates for Video-Assisted Thoracic Surgery (VATS) for both the diagnosis and treatment of their tumors. In addition to initial radiology evaluation with CT Scans and PET scans our practice performs the spectrum of current, minimally invasive diagnostic and staging procedures including flexible and rigid bronchoscopy, navigational bronchoscopy (ENB), endobronchial ultra-sound (EBUS), and endoscopic ultrasound (EUS) and video-mediastinoscopy.

VIDEO-ASSISTED THORACIC SURGERY (VATS)
VATS procedures can be used for a variety of chest surgical procedures including treatment of benign and malignant conditions of the lung, pleura, mediastinum and esophagus.

At times a VATS procedure is the most accurate test to determine if a small lung nodule is benign or malignant. We routinely perform VATS wedge resections for diagnosis and lobectomies for treatment of lung cancer and masses with excellent results and high levels of patient satisfaction. When dealing with large, centrally located tumors or tumors involving the chest wall, we perform open thoracotomy procedures as well.

Developed in the early 1990's, this minimally-invasive technique for accessing the chest for surgery has been demonstrated to be highly effective while dramatically improving a patient’s operative experience – reducing operative times and hospitalization and shortening time to recovery.

Patients undergoing VATS have far fewer complications than traditional open-chest surgery patients and usually avoid severe chronic chest wall pain, a common problem with conventional open thoracotomy (incision into the chest). VATS patients rarely require intensive care, and most patients are able to eat and walk on the day of surgery. Many patients can go home within two days and return to full activity within two weeks. This is a dramatic improvement over traditional open thoracotomy chest surgery, which usually requires a 7-10 day hospital stay and a 6-8 week recovery time.

In traditional chest surgery via open Thoracotomy, the surgeon makes a large incision – approximately 10 to 14 inches – and spreads/cuts the ribs in order to operate inside the chest cavity. By contrast, with VATS the surgeon makes a small – approximately one-inch – incision and inserts an endoscope (a tiny telescope connected to a video camera) thus giving the surgeon a magnified view of the patient’s internal chest cavity on a video monitor. Guided by that image, the surgeon then can perform a full range of chest surgery procedures working with instruments through the other small incisions.

When indicated, patients with more advanced tumors are selectively offered up-front (neoadjuvant) treatment with chemotherapy and radiation therapy for down-staging. Postoperative (adjuvant) chemo and radiation therapy referrals are made in accordance with national guidelines and protocols via our participation with the Eastern Cooperative Oncology Group (ECOG), the American College of Surgeons Commission on Cancer, the National Institutes of Health (NIH) and the Cancer Institute of New Jersey (CINJ).

Our lung cancer surgery program through The Carol G. Simon Cancer Center at Morristown Medical Center and Overlook Medical Center offers patients outstanding care. Recently, our lung surgery program received an exemplary status rating by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Magnet award winning nurses staff the dedicated post operative inter-mediate care unit. Patients all have private rooms equipped with telemetry monitoring. Atlantic Heath has a nationally recognized outstanding respiratory therapy program that offers assistance in monitoring and enhancing patient progress and recovery. We also have access to social worker support dedicated to lung cancer patients for assistance in the pre- and post-operative setting. Smoking cessation and nutritional support is offered as well. Our team consults when necessary in a multi-disciplinary approach with colleagues from other specialities including pulmonary medicine, medical oncology, radiation therapy, ENT, infectious disease and cardiology.

PNEUMOTHORAX
A pneumothorax is a build up of gas outside the lung in the chest cavity that causes collapse of the functioning lung. Usually this is due to rupture of a pockets called blebs. It can occur spontaneously in healthy patients or be due to underlying lung disease. Most patients require chest tube drainage to allow the lung to reinflate. Select patients require surgery (usually a VATS procedure) to resect the area of blebs and create pleuredesis (fusion between the lung and chest wall) to prevent recurrent collapse.

EFFUSION/EMPYEMA
Effusions (fluid) can build up outside the lung inside the chest as a result of pneumonia or other infections/tumor or inflammation. Depending on the circumstances patients may require needle drainage (thoracentesis), chest tube drainage, or operative drainage. When operative drainage is required this is often amenable to a VATS approach.

MEDIASTINAL DISORDERS
A wide variety of conditions can cause enlargement of lymph nodes or create tumors of the middle of the chest (mediastinum). We can sample lymph nodes with a variety of approaches including video- medistinoscopy, EBUS, EUS, VATS, and Navigational Bronchoscopy (ENB).

We routinely use VATS techniques to diagnose and drain pericardial effusions and cysts.

For other masses of the mediastinum including bronchogenic cysts, neurogenic tumors, and tumors of the thymus gland (Thymoma), we can frequently remove the tumor using VATS techniques, and avoid the pain and disability of open thoracotomy and trans-sternal approaches.

MESOTHELIOMA (PLEURAL TUMORS)
Mesothelioma is a cancer of the lining of the lung that affects approximately 2,000-3,000 people in the U.S. annually. It is considered an aggressive type of cancer and has been associated with past exposure to asbestos. Surgical resection is indicated for mesothelioma when the cancer is diagnosed at an early stage. After carefully determining which patients are eligible for surgery, two different types of procedures are offered: Pleurectomy and Extrapleural Pneumonectomy. Pleurectomy involves removing the lining of the lung and chest wall that is involved with the tumor. Extrapleural Pneumonectomy involves removal of the chest wall lining, lung, diaphragm, and the tissue around the heart (pericardium) as one whole specimen. Chemotherapy with radiation is offered before or after surgery, depending on how advanced the tumor is upon initial patient evaluation.

STENTS
A stent is a tube inserted into the esophagus or airway that prevents obstruction caused by a tumor. We have extensive experience with the insertion of different types of stents that are effective in improving a patient’s quality of life by enhancing their ability to eat or breathe. Some patients require removable stents during chemotherapy or radiation before definitive surgery in order to help them do well during their pre-operative treatment. Other patients require permanent stents in the esophagus or airway system for definitive treatment if surgery is not an option.