Definition and Overview

Thoracic surgery is a field of medicine that deals with the diagnosis and surgical treatment of conditions caused by illness or injury in the oesophagus, lungs, heart, and other structures inside the chest. Thoracic surgery involves the expertise of various types of surgeons, including cardiothoracic, congenital heart, general thoracic, and cardiovascular surgeons.

Thoracic surgery can address different types of conditions, such as lung cancer, tumours and benign growths in the lung, oesophageal cancer, achalasia and other swallowing issues, strictures and tumours in the oesophagus, gastroesophageal reflux, mesothelioma, lung infections and effusions, tumours in the chest wall, hyperhidrosis, and more. Thoracic surgeons can also perform lung transplants (especially for patients with end-stage lung diseases), resection the trachea, and remove blockages in the heart and arteries.

Thoracic surgery is different from the fields of cardiology and pulmonary medicine—though they deal with the same organs, structures, and location— mainly because they dispense surgical treatment or intervention. Cardiologists diagnose heart conditions and diseases, and then prescribe medication to treat them. They can also sometimes perform treatment by accessing the heart and the arteries through small incisions in the patient’s groin. Pulmonologists function in a similar manner—they diagnose and prescribe medication, and perform minimally invasive procedures such as bronchoscopy.

Who Should Undergo and Expected Results

Patients who require surgical treatment or intervention for diseases or injuries of the oesophagus, heart, chest walls, and lungs should undergo thoracic surgery. Typically, primary care physicians such as general practitioners, pulmonologists, cardiologists, and gastroenterologists refer their patients for thoracic surgery when they see fit.

Cardiovascular surgeons can treat patients suffering from leaking heart valves, heart failures, heart valve blockages, coronary artery disease, atrial fibrillation, and aneurysms in the major arteries in the chest.

General thoracic surgeons can perform life-saving or life-extending procedures for patients suffering from hiatal hernias, severe emphysema, lung cancer, swallowing disorders, excessive sweating, gastroesophageal reflux disease, and oesophageal cancer.

Congenital heart surgeons, on the other hand, can surgically treat coarctations of the aorta, atrial and ventricular septal defects, hypoplastic syndrome, and transposition of the major arteries.

The expected result of thoracic surgery is either completely treating the condition or restoring the initial function of the affected organs and structures (in the event of damage caused by injury or illness). In the case where complete treatment is not expected, the patient can at least experience relief from the signs and symptoms of the disease.

How is the Procedure Performed?

The techniques and approaches used in thoracic surgery highly depend on the location of the affected organ or structure. The surgery can involve invasive or minimally invasive methods. In cardiothoracic surgery, for example, open-heart surgery is a common approach used to treat issues in the internal cardiac structures. In this method, the surgical team will temporarily stop the heart and drain it of blood before starting the procedure. However, the primitive version of this surgical procedure ended up posing technical problems for surgeons and actual, life-threatening risks for the patients, and it was soon improved with the use of a heart-lung machine.

If the structure or organ to be operated on is located behind the ribs, traditional techniques involve cutting through the bone to gain access to them.

There are also minimally invasive procedures that significantly reduce the amount of time of both the surgical procedure and the patient’s recovery time. In the field of cardiothoracic surgery, there is a growing trend for robot-assisted surgery. A specially designed machine is used to assist the doctor with the operation to achieve increased accuracy and precision. The incision does not have to cover the entire chest area and there is no need to open the ribcage. The surgeon will only have to make small incisions for the machine’s “arms” to pass through the chest walls.

Possible Complications and Risks

There are many risks and complications involved in thoracic surgery though deaths or fatal complications are relatively low. Modern technology has allowed thoracic surgeons to be more precise and accurate with their methods and techniques, lowering the risk of infection and other serious complications.

However, it is important to note that patients undergoing cardiothoracic procedures are at high risk of neurological damage, with stroke being the leading complication of such operations. This is because the methods associated with such practice have significant risks to the neurological structures. However, the primary care physician, cardiologist, and the thoracic surgeon will only proceed with the surgery if initial assessment confirms that the benefits greatly outweigh the possible risks and complications.

Infections are also very common complications of thoracic surgery. Patients undergoing surgery for the heart can suffer from infections in the blood stream, cardiac device infection, empyema, pneumonia, mediastinitis, endocarditis, pericarditis, and more.

References:

  • Putnam JB Jr. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 58.

  • Tsiouris A, Horst HM, Paone G, Hodari A, Eichenhorn M, Rubinfeld I. Preoperative risk stratification for thoracic surgery using the American College of Surgeons National Surgical Quality Improvement Program data set: Functional status predicts morbidity and mortality. J Surg Res. 2012: epub ahead of print.

  • Wiener-Kronish JP, Shepherd KE, Bapoje SR, Albert RK. Preoperative evaluation. In: Mason RJ, Broaddus C, Martin T, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier;2010:chap 26.

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