Surgery for Lung Cancer

Lung cancer is epidemic and is now the leading cancer killer among both men and women. We consider excellence in surgery for lung cancer to be at the core of the mission of the Thoracic Surgery service at Penn. Surgery for non-small cell lung cancer makes up more of our surgical volume than any other category of procedure (Chart 1), and this places us among the busiest centers for lung cancer surgery in the world.

Patients come to Penn for surgical treatment of lung cancer not only from the Philadelphia region, but also from across the nation, and we believe our results set the standard for the treatment of patients with this condition.

A guiding philosophy in our management of resectable lung cancer is to achieve the highest cure rate possible, while maximally preserving functioning lung parenchyma. This approach can only be practiced by surgeons skilled in sleeve lobectomy and experienced enough to know when lobectomy will provide an equivalent chance of cure as the more morbid pneumonectomy. This reduces both early complications and longterm disability due to dyspnea.

In the last year, the pneumonectomy rate at the Hospital of the University of Pennsylvania (number of pneumoctomies/total number of resections for lung cancer) was less than one-half that of the average rate at all other hospitals in Pennsylvania (Chart 2). Our low rate of pneumonectomy and our overall low complication rate at the Hospital of the University of Pennsylvania allows us to maintain the lowest length of stay for the “major thoracic” category of discharges among hospitals in the Philadelphia region*.

Another skill that we at Penn have, as subspecialists in thoracic surgery, is the ability to perform pulmonary segmentectomy. This technique, which involves removal of the smallest anatomic unit of lung tissue — less than an entire lobe — will often allow an adequate cancer resection to be performed in patients with severe emphysema who in other institutions might not have been considered to be operative candidates. The ability to perform segmentectomies as well as the application of the concept of lung volume reduction (see next section on surgery for emphysema) allows us to extend safe surgical resection of lung cancer to many patients with even severe chronic obstructive pulmonary disease. Thoracoscopy has played a progressively larger role in the management of lung cancer, and Penn thoracic surgeons continue to be in this vanguard.

Thoracoscopy was initially used only as a diagnostic procedure in lung cancer, but as it has become clear that stage I lung cancer can be appropriately managed by thoracoscopic lobectomy, we have adopted this approach in selected patients. The number of cases of thoracoscopic (VATS) lobectomy performed at Penn has increased exponentially in the last several years (Chart 3), and we expect it to continue to rise in the future. In addition, many of our lung cancer operations are performed through totally muscle-sparing, axillary thoracotomy incisions which are both cosmetically appealing and preserve arm strength.

As in all areas of thoracic surgery, Penn surgeons have not only skillfully applied current knowledge in the field of lung cancer surgery; they have also advanced the field by innovation and dissemination of clinical results. Among the areas of lung cancer surgery in which we have published in the past several years are: the role of lobectomy with pulmonary artery resection and reconstruction as an alternative to pneumonectomy, levels of pain and return to physical functioning following muscle-sparing versus lateral thoracotomy, and the effect of various adjuvant therapies in combination with surgery for non-small cell lung cancer.

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.

Visitor Information:

	-	HUP
	-	Penn Presbyterian
	-	Pennsylvania Hospital
	-	Penn Medicine at Cherry Hill