A thoracic surgeon specializes in treating the organs in the chest. This includes the lungs, esophagus and the trachea. The most common surgeries performed by a thoracic surgeon include treating lung diseases and also performing anti-reflux surgeries. A thoracic surgeon first completes a general surgery residency and then goes on to complete additional training in a fellowship where they focus exclusively on the organs of the chest. This area of medicine has benefitted from the innovation and advancements in minimally invasive and robotic-assisted surgical techniques. While most of the procedures that are performed are elective, sometimes a thoracic surgeon may be called-in to reconstruct the organs in the chest after a traumatic injury or accident.
- Lung – tumors (benign and cancer (malignant), lung infections, empyema, hemothorax, pneumothorax, pleural effusion, need for lung or pleural biopsy (interstitial lung disease, infection, etc)
- Esophagus – achalasia, benign tumors, cancer, gastroesophageal reflux (GERD), perforation
- Trachea – fistulas, stenosis, benign tumors, cancer
- Thymus – thymomas (tumors benign or cancer), myasthenia gravis
At each link below is further information on thoracic surgeries performed and diseases treated.
There are several reasons that a patient may need surgery on the lung. It may be for a biopsy or the treatment of either benign diseases and tumors of the lungs, lung infections from pneumonia or emphysema which may involve reducing fluid in the lungs, or lung cancer. Lung biopsies or pleural biopsies are most often done to identify interstitial lung diseases or fluid on the chest. When a patient has a condition involving the lungs they should always seek out a board-certified doctor and with surgery of the lung it is important to see a thoracic specialist.
Lung cancer is a disease that would often be treated by a thoracic surgeon. If lung cancer is suspected because a spot has been detected on the lung, a patient can expect to have a variety of tests to help achieve an accurate diagnosis. They will first undergo an evaluation and medical history, followed by a chest x-ray, CT scans or PET scans. The thoracic surgeon may also take a lung biopsy.
If it is determined that an individual has lung cancer, the goal will be to surgically remove the lung or the cancerous tumors. Lung surgery can be approached in several ways, depending on what the surgeon needs to achieve. Lung surgery can be done as an open procedure, robotic-assisted surgery or even thoracoscopically. Because each person is different and every individual case is unique, each individual situation may necessitate a different approach. The location of the tumor and the complexity of the procedure will both be considered as the surgeon evaluates and recommends the type of surgery that will be best suited to achieve the optimal outcome.
Individuals can live without a lung, or with a partial lung. It is always the goal of the surgeon to try to preserve as much of the lung tissue as possible, while effectively treating the disease. After lung surgery individuals may be in the hospital from 2 – 5 days. They often experience soreness and it is recommended that after lung surgery, individuals refrain from strenuous activity for 2 – 6 weeks.
A thoracic surgeon also treats other organs in the chest cavity - the esophagus and trachea are two areas that are often treated by a thoracic surgeon. They are well-versed in the surgical treatment of esophageal cancer, gastroesophageal reflux, and benign esophageal diseases, such as: achalasia, benign tumors and strictures.
Surgery to correct reflux, often referred to as GERD, is known as Nissen fundoplication. It is a procedure that is performed when the traditional medicines and treatments have failed. Anti-reflux surgery is performed laparoscopically, and it is considered to therefore be a minimally invasive procedure. In this procedure the surgeon corrects the valve mechanism at the bottom of the esophagus so that stomach acid cannot travel back up the esophagus.
It is important to treat reflux, because it is suggested that the long-term effects of chronic irritation to the lining of the esophagus may contribute to the changes that cause esophageal cancer. The long-term effects of reflux and smoking are risk factors for esophageal cancer. For individuals who have esophageal cancer they may need to have the esophagus removed, this is known as an esophagectomy. The esophagus is the tube that travels from the mouth to the stomach. The surgeon then performs esophageal reconstruction where the stomach is pulled up and connected to the remaining esophagus.
Surgery on the trachea, also known as the windpipe, is also often addressed by a thoracic surgeon. Trachea surgery is less common, but there are a variety of diseases or disorders that can affect the function of the trachea:
- Fistulas - abnormal connections between the esophagus and trachea
- Stenosis a narrowing of the trachea
- Benign and cancerous tumors
These are the most common reasons that individuals may need surgery on the trachea. If a surgeon is removing a tumor, repairing a fistula or treating a narrowing airway, the surgeon may insert a stent that can help expand the airway.
A thoracic surgeon also treats the thymus gland. The thymus gland is a small organ that is located behind the breastbone or sternum. It is a part of the immune system. The thymus gland can get tumors, also known as thymomas, either benign or cancerous that may lead to the need for a thymectomy, which is the removal of the thymus gland. Removal of the thymus gland has not been shown to have an adverse effect on the immune system. Another condition, myasthenia gravis, is a neuromuscular disease that leads to the need to remove the thymus. What was once a major surgery requiring several days in the hospital and weeks to recover, can now also be done with minimally invasive techniques. With advances in robotic surgery, surgeons are now able to complete this surgery with much smaller incisions and patients can expect a quick recovery, usually spending only a day in the hospital.