Thoracic surgery

Traditionally, it was only cases of early lung cancer that were referred for surgical resection. In addition to these cases we also review many cases of locally advanced lung cancer (T3/T4) or when there is limited spread (N2) and in highly selected patients metastatic disease (M1).

All such cases are discussed in a multidisciplinary group and if appropriate we may be able to offer surgery supported by additional treatments such as chemotherapy and radiotherapy. We receive requests for second opinions and also consider patients for surgery when other options may have been unsuccessful.

In November 2019, a team at Royal Papworth Hospital, led by surgeon Mr Giuseppe Aresu, performed a world-first surgery to treat stage 3B lung cancer. 

Royal Papworth has among the best survival rates for thoracic surgery for lung cancer in the country. 

Including sleeve resections, other lung-sparing surgery, chest wall resections and resections involving the heart or great vessels.

If appropriate, small incisions are advised to help improve recovery times for patients following surgery. This is performed with the help of small operating telescopes which often give an excellent view and is known as keyhole, ‘video-assisted’ or ‘VAT’ surgery.

In November 2018, a team at Royal Papworth Hospital - led by surgeon Mr Giuseppe Aresu - became the first in Europe to remove a chest tumour using a minimally-invasive technique. 

In November 2019, Mr Aresu also performed the world's first removal of an entire lung through a small incision of just two inches. 

Each person is assessed on their own merits. Some patients may have been advised that they are inoperable due to poor lung function. Our approach is to try to improve their breathing and other illnesses to see if they can tolerate an operation. If surgery is performed we may advise a lung-sparing approach, and such patients benefit from our experienced specialist intensive and nursing care.

This established treatment can help some people by removing poorly functioning parts of the lung which allows the rest of the lung to work better and also reduces the effort needed to breath.
 

Royal Papworth Hospital offer an 'easy-access pleural service'. Historically, many patients with pleural disease would have several procedures before a diagnosis was reached; we are of the opinion that repeated cannulation of the pleural space should not be performed and we encourage referral as early as possible. Our aim in managing pleural space problems is to achieve a diagnosis and to alleviate the problem in as few as steps as possible.

We have expertise in the management of pneumothorax, pleural effusions, empyema and pleural tumors such as mesothelioma. The management of mesothelioma is quite controversial and whenever possible we encourage patients to participate in research both designed to help them and to find out the best treatments for mesothelioma.

Including cancer resections for lung cancer, primary chest wall tumours, secondary tumours to the chest wall and post-pneumonectomy empyema. 

We have experience of different systems for chest wall stabilisation and reconstruction after surgery.
 

We have a particular interest in pectus operations and sometimes operate with plastic surgery colleagues to produce the best results.
 

We have a long-standing interest in surgery of the airway, and successfully perform tracheal resections and have treated some cases of trachea-oesophageal fistula. There is a comprehensive endobronchial airway service which is offered jointly by surgeons and physicians and we are able to offer cryotherapy, endobronchial resection, flexible and rigid bronchoscopy, and stenting.

Tumors and cysts occur in the mediastinum (the region located between the lungs that contains all the principal tissues and organs of the chest except the lungs) and we offer a range of operations for these patients. 

 

Some people with mestastases to the chest may benefit from resection of these tumors. Each case is very carefully assessed by a range of multidiscplinary staff to allow the best decision to be made for the patient.
 

Sarcomas are a form of tumour which have particular requirements. We work with oncologists who also have a special interest in this area, again with the aim of getting the best results.