ANN ARBOR, MI - A new surgical technique offered at the University of Michigan Comprehensive Cancer Center is helping people with early stage lung cancer recover more quickly with less pain.

Allan Pickens, M.D.

The minimally invasive technique involves removing a portion of the lung without cutting large muscles or spreading open the ribs. As a result, patients leave the hospital in half the time of conventional lung surgery, and they can usually return to work in only two weeks. With a traditional thoracotomy, patients remain in the hospital as long as a week after surgery.

“It's a way of treating cancer with a less invasive procedure that will get patients back to their regular activities sooner,” says Allan Pickens, M.D., a thoracic surgeon at the U-M Comprehensive Cancer Center and lecturer in surgery at the U-M Medical School. Pickens recently completed fellowship training to learn this procedure. Since coming to U-M in January, he's performed about 20 of the procedures, called thoracoscopic lobectomies. U-M is one of a select few centers nationwide offering the procedure.

Traditional lung cancer surgery is a thoracotomy, in which the surgeon cuts through the muscles into the chest and spreads open the ribs to access the lungs. The incision is large, about 20 centimeters, and recovery is slow and painful.

With the new technique, thoracoscopic lobectomy, the surgeon makes three small incisions of 2 centimeters to 4 centimeters each. A camera is inserted through a fourth incision that is only half a centimeter long. The camera allows the surgeon to see inside the chest. Very little muscle is cut and the ribs do not need to be spread.

“Thoracotomy is one of the more painful operations surgeons perform. It cuts into the muscles in a dynamic part of the body, an area that moves a lot from breathing. This makes it harder to heal afterward,” Pickens says.

Surgeons are seeing better pulmonary function, a measure of how well a person can take a deep breath, in patients who have the minimally invasive procedure compared to thoracotomy patients. In addition to going home sooner, recovery is easier and requires fewer narcotic painkillers. Initial research suggests cancer survival rates are similar for both procedures.

Thoracoscopic lobectomy is primarily done in patients with stage I or stage II disease, meaning the nodule is smaller than 5 centimeters, has not invaded the chest wall and has not spread to distant organs. More advanced cancer will still require traditional thoracotomy.

In lung cancer treated with thoracoscopic lobectomy, the entire lobe is removed, called a lobectomy. The same procedure may also be used to remove a portion of the lung, called a wedge resection. In some cases, surgeons can perform a wedge resection to biopsy a nodule, and then proceed if it is cancerous to the full lobectomy at the same time. This may eliminate the need for needle biopsies or additional surgeries. Thoracoscopic lobectomy can be used for any disease of the chest or lung.

Results to date have been positive. Among the first 1,100 patients to receive this surgery, mortality rates were below 1 percent. The most common complication was air leaking through staple lines, a condition that typically resolves on its own.

“This is the way thoracic surgery is moving toward for lung cancer treatment. It's a technology I think in my heart improves medical care,” Pickens says.

For more information about lung cancer, visit http://www.cancer.med.umich.edu/learn/lung.htm or call the Cancer AnswerLine at 800-865-1125. For information about thoracic surgery at the U-M Health System, go to http://thoracic.um-surgery.org/.

Written by Nicole Fawcett

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