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Thoracic surgery

Team of doctors:
Assoz. Prof. Priv.-Doz. Dr. F. Augustin, MBA
OA Dr. P. Lucciarini
Priv.-Doz. Dr. Herbert Maier
Ao. Univ.-Prof. Dr. H. Wykypiel, FEBS/FEBTS UGI

Special consultation hour
Mittwoch 9.00 bis 15.30
Tel. +43 (0)50 504 50010

All surgical diseases of the lung, the respiratory tract and the pleura are covered by our working group. Of course, minimally invasive surgical methods and robotic surgery are also applied in the thoracic area.

Lung cancer (bronchial carcinoma)

Minimally invasive operations, i.e. so-called condylar surgery, are less painful for the patient and shorten the hospital stay. In Austria, we are the department with the most experience with such operations in the treatment of lung cancer. 

Video example for minimally invasive lung surgery with only one small incision

Our experience in this field has led to invitations to actively participate in international congresses and workshops. 2nd International VATS Lobectomy Congress 2010, Edinburgh; Congress of the German Society for Thoracic Surgery 2010, Regensburg; Congress of the German, Austrian and Swiss Society for Thoracic Surgery D-A-CH 2010, Vienna). In April 2010 we held a highly acclaimed surgery course on minimally invasive treatment of lung cancer for thoracic surgeons from Switzerland, Germany and Austria.

What is lung cancer? 

Lung cancer is a degeneration of the tissue in different areas of the lung. This includes not only bronchial carcinoma (cancer of the actual lung tissue), but also very rare cancers such as mesothelioma (cancer of the lung skin). Bronchial carcinoma occurs most frequently between the ages of 65 and 70 and is the most common type of cancer in men after prostate carcinoma. Smoking is the cause of this disease in about 90 percent of cases. The current trend shows that although more and more men are giving up smoking, more and more women are starting to do so. This is reflected in the statistics on new cases of bronchial carcinoma in women, in which bronchial carcinoma has now advanced to second place after breast cancer.  Worldwide, bronchial carcinoma is the most common tumor in humans.  The very rare mesothelioma is mainly caused by asbestos. Since this type of tumor does not develop until about 15 to 50 years after exposure, the disease is expected to peak around 2020. If lung cancer is treated at an early stage, it is curable.

What causes lung cancer? 

In most cases, lung cancer is caused by external influences. Cigarette smoke inhalation is responsible for 90 percent of all bronchial carcinomas. Passive smoking leads to an increased risk of cancer. For example, the lung cancer risk for spouses of smokers is 20 percent higher in women and 30 percent higher in men and increases with increasing exposure. Family exposure: People in whom one parent has bronchial carcinoma have a two to three times higher risk of developing the disease. Working materials such as asbestos cause bronchial carcinomas and mesothliomas. Lung scars also represent an increased risk. They occur, for example, after tuberculosis or operations.

Welche Symptome verursacht Lungenkrebs? 

In the early stages there are usually no typical symptoms. Coughing is an important signal, but it can also indicate other diseases such as (chronic) bronchitis. Lung cancer is often only detected when persistent coughing or blood admixture in the sputum is noticed. Only a few cases of lung cancer are discovered by chance during a routine examination of the lungs. Other uncharacteristic symptoms are: loss of appetite, fatigue, weight loss, shortness of breath or fever. Pneumonia that does not respond to treatment (so-called therapy-resistant pneumonia) may indicate lung cancer at the age of 40 or older. Protracted coughing attacks lasting longer than three weeks in smokers for whom drugs are ineffective.

How does the doctor diagnose lung cancer? 

The doctor will first perform an X-ray examination of the lungs. Usually a computer tomography (CT) of the lungs follows.  If all these examinations confirm the suspicion of lung cancer, an additional bronchoscopy (endoscopic examination of the bronchial tubes, "lung endoscopy") or a CT targeted puncture is performed to take a tissue sample. If lymph nodes near the tumor are enlarged in imaging, a small diagnostic operation (mid-field endoscopy = mediastinoscopy) and/or a PET examination (nuclear medical examination) is usually necessary.

How is lung cancer treated? 

The treatment of lung cancer depends on the type of cancer and the extent of the tumor, and if there is no detectable seed in the lymph nodes, the lung cancer is operated on. In this procedure, the cancerous tumor is removed together with a piece of the healthy lung or lung wing. The chances of recovery in such cases are very good. If lymph nodes near the tumor are affected, a combined procedure consisting of chemotherapy and surgery is usually chosen. If the bronchial carcinoma is already in a more advanced stage, it is treated with either chemotherapy or radiotherapy. Often a combination of both therapies (multimodal therapy) is used. A special type of bronchial carcinoma, small cell lung cancer, responds particularly well to radio-chemotherapy and is therefore very rarely operated on. Certain mesotheliomas can be operated on. In most cases, however, this type of tumor is too extensive to be operated on. If a complete cure is not possible, symptoms such as shortness of breath, which are caused by the tumor growing into the trachea, can be relieved. For this purpose, metal grid tubes (stents) can be inserted into the trachea to keep it open or the tumor mass can be reduced by laser or irradiation from inside (endoluminal brachytherapy). Lung cancer often has bone metastases that cause pain. These can be treated with special drugs or nuclear medicine methods.

What can you do yourself to reduce the risk? 

STOP SMOKING! With increasing cigarette consumption, the risk of lung cancer increases, from an 8-fold risk when consuming 1 to 14 cigarettes a day to a 25-fold risk when consuming more than 25 cigarettes a day. It is never too late to stop! The longer you are a non-smoker, the lower the risk of getting lung cancer.  Prognosis If lung cancer can be operated on, there is in principle a complete chance of recovery. In some cases, the tumor can be removed by a relatively small operation, especially if it is located far out in the lung. This involves removing the part of the lung in which the cancer is located. If no lymph nodes are affected, about 60 to 80 percent of patients survive the first five years after surgery.

Inflammation of the lungs and chest cavity

Pneumonia (pneumonia), pleural empyema (collection of pus in the chest cavity), tuberculosis, bronchiectasis, actinomycosis, aspergillosis, lung abscess

Pulmonary emphysema

Pulmonary emphysema is a pathological over-inflation of the lungs. It usually occurs as a result of chronic bronchitis in smokers over the age of 50. Very rarely it is also a congenital enzyme defect (alpha-antitrypsin deficiency), which already leads to emphysema in patients under 40 years of age. There are also occupational causes. Symptoms are reduced performance, shortness of breath, a barrel-shaped chest and chronic cough. The diagnosis is made by medical examination, lung X-ray, lung function test and blood gas analysis. Treatment consists of smoking cessation, bronchodilator drugs, oxygenation. In the advanced stages, in selected cases an improvement of the symptoms can be achieved by a so-called lung volume reduction (LVRS). This operation is usually performed minimally invasive (buttonhole surgery).

Changes of the lung and pleura

Pleural effusion, pleural empyema, pleural mesothelioma, pleural carcinosis

Pneumothorax

The pneumothorax is an accumulation of air in the pleural gap, i.e. between the two layers of the lung membrane. This leads to a partial or complete collapse of one lung, i.e. one half of the lung collapses. Pneumothorax can occur spontaneously, after an accident or after medical interventions such as puntkions. The most common is the spontaneous idiopathic pneumothorax, which occurs without any previous illness and usually affects young, slim men. Treatment is carried out at the first occurrence by applying a simple pulmonary cavity drainage (office drainage), in case of a recurrence (relapse) a surgical intervention is recommended. In most cases, a minimally invasive, thoracoscopic procedure (buttonhole surgery) is sufficient.

Funnel Breast 

This deformity of the rib cage is probably caused by a ferment metabolic disorder of the rib cartilage. A familial disorder is often found. Today, we also correct these changes in a minimally invasive way (buttonhole surgery) by means of surgery according to Nuss, in which a stabilizing metal line is inserted for a certain period of time. Due to the elasticity of the thorax, the ideal time for the operation is shortly before puberty, but it can also be performed in adulthood. The laterally located scars are hardly visible.

Tumors of the thoracic wall

Benign: fibromas, lipomas, granulomas Malignancy: sarcomas, secondary (recurrences especially with e.g. breast carcinoma)

Congenital malformations of the lung

Bronchogenic cyst, congenital bronchial atresia, pulmonary dysplasia, pulmonary cysts, arterio-venous malformations, pulmonary sequester Depending on the symptoms, the treatment of these malformations consists of surgical removal of the affected alteration or part of the lung. Ideally, the operations should be performed as early as possible, sometimes even in infancy.

Thoracic traumas

Lung contusions, tears of lung parenchyma, trachea, bronchia, esophagus, hematothorax (bleeding into the pleura), traumatic pneumothorax