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<h2><span style="color: #00826a;">Getting to Know Lung Cancer First<strong><br />
</strong></span></h2>
<p>Lung cancer is divided into two major types: small cell lung cancer and non-small cell lung cancer, with the latter accounting for up to 85% of all lung cancers.</p>
<p>Currently, lung cancer is treated with medication and surgery, which respond quite well to treatment. Dr. Kittichai Luangtaweeboon, a thoracic surgery specialist at Phyathai 2 Hospital, will explain the advantages and disadvantages of thoracoscopic surgery for non-small cell lung cancer, as well as details about the treatment.</p>
<h2><span style="color: #00826a;">Thoracoscopic Surgery for Non-Small Cell Lung Cancer: Advantages and Disadvantages</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Thoracoscopic surgery, or video-assisted thoracic surgery (VATS), is performed to reduce the size of the surgical wound. Normally, in open chest surgery, the surgeon must cut one chest muscle, the latissimus dorsi, and dissect the serratus anterior muscle, as well as cut the intercostal muscles, which slightly affects breathing. Patients may experience coughing with pain, making them reluctant to cough forcefully or breathe deeply, which increases the risk of lung collapse and also affects shoulder movement.</p>
<p>The open surgery and thoracoscopic surgery methods are the same in that blood vessels and bronchi are separated and lymph nodes dissected. The difference is that in thoracoscopic surgery, the surgeon does not directly touch the tissue and cannot palpate the lung nodule, so assistance such as coils or dye injection is needed to locate the nodule. If the nodule is deeper than 1 centimeter from the lung surface, thoracoscopic surgery requires the use of automatic stapling devices to divide and suture pulmonary vessels and bronchi, which are more expensive than tying or suturing with thread. The cost per stapling device is nearly ten thousand baht, and each patient may require up to five devices, totaling about fifty thousand baht just for the stapling instruments.</p>
<p>Studies have found that for surgeons experienced in thoracoscopic surgery, the operation time may not be longer than open surgery. The advantages of thoracoscopic surgery include less postoperative pain, possibly fewer early complications, and about one day shorter hospital stay. However, the cancer treatment outcomes may not differ significantly from open surgery. The cure rate for stage 1 cancer shows similar results.</p>
<h2><span style="color: #00826a;">Wound Care and Recovery</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Chest wall muscle cutting during surgery has no long-term adverse effects. Pain caused by rib spreading is usually mild, but there may be tingling under the breast due to rib suturing.</p>
<p>After open surgery, nerves supplying the skin under the same side breast may be tied. The sutures usually dissolve within 2 months after surgery, so tingling and numbness gradually improve. Patient movement aids wound healing and prevents shoulder stiffness, a long-term problem that is difficult to treat but can be prevented by moving the shoulder immediately after surgery.</p>
<h2><span style="color: #00826a;">Definition of Thoracoscopic Lobectomy</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p><span style="color: #00826a;"><strong>In 2012, a conference defined “thoracoscopic lobectomy” as:</strong></span></p>
<ol>
<li>No use of rib-spreading instruments</li>
<li>Incision length not exceeding 8 centimeters</li>
<li>Separate dissection of blood vessels and bronchi, usually using automatic stapling devices to divide and suture vessels and bronchi. Currently, there are no large incisions; surgery is performed through 1-3 small chest ports.</li>
</ol>
<h2><span style="color: #00826a;">Indications for VATS Lobectomy</span></h2>
<ol>
<li>Lung cancer smaller than 6 centimeters</li>
<li>Stage 1 or stage 2 cancer</li>
<li>No abnormalities in mediastinal lymph nodes near the main bronchi</li>
</ol>
<p>Patients with poor lung function who cannot tolerate one-lung ventilation cannot undergo this surgery because it interferes with the camera view, unlike open surgery which may still be possible. Patients with extensive pleural adhesions, such as those with previous thoracic surgery or pleural infections, may find thoracoscopic surgery more difficult than open surgery.</p>
<p>&nbsp;</p>
<div style="text-align: right;"><span style="color: #00826a;"><strong>Dr. Kittichai Luangtaweeboon</strong></span></div>
<div style="text-align: right;">Cardiovascular and Thoracic Specialist</div>
<div style="text-align: right;">Heart Center, Phyathai 2 Hospital</div>


Lung cancer has two main types: small cell and non-small cell, with the latter accounting for up to 85%. Currently, treatment includes medication and surgery, which are considered effective.

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