Thoracic diagnostics and surgery

When are lung and pulmonary diseases treated with surgery?

In the lungs there are both non-malignant and malignant tumours, the most common of which is lung cancer. Sometimes surgery is the ultimate way to find out which group a tumour belongs to. Thus, tumours suspected to be non-malignant are often recommended to be removed to verify the tumour type.

Pre-surgery tests are used to evaluate tumour size in a lung cancer patient; based on these tests, the spread of tumours is determined, and the appropriate treatment method can be decided. Lung cancer surgery is possible in those patients whose cancer has not spread beyond the lung.

Other prerequisites for lung cancer surgery are sufficiently good state of health of the patient pre-surgery to withstand the stress caused by surgery, and adequate functioning of the lung post-surgery, which is measured by lung function tests such as spirometry. Thoracic tumours are rare and surgical treatment is not usually appropriate.

Inflammation of the pleural sacks is not uncommon and may occur independently or as part of pneumonia. If it is not possible to draw the fluid out via a canula and chest drain, surgery is required to improve the patient’s condition.

What happens during surgery?

The surgical procedure is explained by the surgeon and the anaesthetist before the procedure, often already during the polyclinic visit. The patient will arrive in the surgery ward on the afternoon prior to surgery, or on the morning of the surgery. Thoracic surgery is performed in the operating theatre under full anaesthesia. Nowadays, an increasing number of surgeries are performed as keyhole procedures. In this case, several small cuts are made to the side of the patient, through which the camera and instruments required for the operation are operated. Keyhole surgery is not possible in all cases, and surgery would then be performed via an incision in the side of the patient, between the ribs.

In keyhole surgery, a thin catheter is applied to the wound to treat pain. This supplements oral analgesia. In painful open heart surgery, pain is treated with epidural anaesthesia. The patient comes in the operating theatre and is then transferred to the recovery room (part of Heart Hospital’s intensive care department) for monitoring.

During keyhole surgery, a thin catheter is inserted into the cut to administer a painkiller. During open heart surgery, pain relief is administered via epidural. The patient comes in the operating theatre and is then transferred to the recovery room (part of Heart Hospital’s intensive care unit) for monitoring.

After both surgeries, a chest drain is led down from the thorax, through which tissue fluid and air passes into a collecting vessel that is connected to the suction. The discharge tube is removed a few days after the surgery in the ward. On the day after the operation the patient is instructed to get up and be mobile. Even on the day of the surgery, the patient is given instructions for breathing exercise.

The ward stay after keyhole surgery is 3-5 days and after open heart surgery 5-7 days.

Are there any risks associated with the surgery?

There are always risks associated with thoracic surgery, and those will be discussed before surgery. The benefits of surgery must be greater than the risk. The likelihood of prolonged treatment and need for supplementary therapeutic measures is always high in the case of pulmonary surgery. The risk of serious adverse events is small, however.

How does life continue after surgery?

On discharge, the patient can take care of everyday tasks independently. A post-surgery check is performed within a few weeks of the surgery, when the final sample responses are also known.

This final assessment determines the need for other treatments. Possible follow-up monitoring is also planned at this post-surgery check

At the rehabilitation stage, the patient is encouraged to return to their pre-surgery activities as soon as possible. It is recommended that the patient avoids strenuous activities that leave them breathless and heavy lifting for 3 weeks after keyhole surgery and 5 weeks after open heart surgery. This is also the average length of sick leave after surgery.