Thoracic Oncology Surgery

Cancers of the chest, removed through small cuts. Within a planned sequence of treatment.

In CheckMate 816, adding nivolumab to chemotherapy before lung cancer surgery raised median event-free survival from 20.8 to 31.6 months.

Which cancers it treats

Organs inside the chest

Thoracic surgeons operate on cancers of the lung, the airways, the esophagus, the thymus and other structures in the mediastinum, the pleura and the chest wall, as well as on cancers from elsewhere that have spread to the lung. Lung cancer is by far the most common. Non-small-cell lung cancer found at stage I or II, and some stage III cancers after treatment to shrink them, can be cured by removing the lobe or segment that holds the tumor with its lymph nodes, while small-cell lung cancer is treated mainly with chemotherapy and radiotherapy and only rarely with surgery. Thymomas, which grow in the front of the chest, are removed whole together with the thymus gland. Esophageal cancers are removed after chemotherapy or chemoradiotherapy. A few metastases in the lung from bowel, kidney or bone cancers come out when the original cancer is controlled, and tumors of the ribs and chest wall are removed and the gap rebuilt with mesh or bone substitutes.

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Symptoms that call for a chest scan include

1. a cough lasting more than three weeks,
2. coughing up blood,
3. a hoarse voice that does not settle,
4. and unexplained weight loss or chest pain.

Staging comes first

Bring to the first review

• CT and PET-CT images,
• the biopsy and molecular reports,
• and breathing test results.

Accurate staging prevents an operation that cannot help.

Lung cancer treatment around the operation

For many years, chemotherapy before or after lung cancer surgery added only a small benefit. Recent trials have changed that. In CheckMate 816, patients with stage IB to IIIA resectable non-small-cell lung cancer were randomized to nivolumab with chemotherapy or chemotherapy alone before surgery. Median event-free survival was 31.6 months against 20.8 months, and no viable tumor remained at operation in 24.0 percent against 2.2 percent, while more patients in the nivolumab group reached surgery, 83.2 against 75.4 percent.

ADAURA tested osimertinib, a tablet that targets EGFR mutations, for three years after complete resection in 682 patients. At two years, 89 percent of patients on osimertinib were alive and free of disease against 52 percent on placebo.

The CheckMate 816 results also showed

• similar rates of serious side effects in both groups,
• and no delay to the operation from adding nivolumab.

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What this means for you

Your biopsy is tested before surgery so that the right drugs are planned around the operation.

The operation is now one part of a planned sequence.

When bigger surgery does not help

Mesothelioma, a cancer of the pleura linked to asbestos, shows why surgery must be tested like any other treatment. In the British MARS 2 trial, 335 patients with resectable pleural mesothelioma were randomized after two cycles of chemotherapy to extended pleurectomy decortication plus chemotherapy, or chemotherapy alone. Median survival was 19.3 months with surgery and 24.8 months without it. Serious adverse events were 3.6 times more frequent after surgery. Chemotherapy and immunotherapy are now the mainstay for most patients, with surgery kept for diagnosis, drainage of fluid and selected cases discussed at specialist tumor boards, which is a good example of why we recommend an operation only when the evidence shows it helps.

How the operation is done

Most lung and thymus operations are done by keyhole surgery, called VATS, or with a surgical robot, through three or four cuts of one to four centimeters between the ribs. Larger tumors, those invading the chest wall or major vessels, and some operations after chemoradiotherapy are done through an open incision.

Risks and how they are managed

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The recovery

After keyhole lung surgery, patients sit out of bed on the day of surgery, walk on the first day and go home after three to five days once the drain is out and the X-ray shows the lung fully expanded. Breathing exercises continue at home. A small device that you breathe into several times an hour, taught by the physiotherapist, keeps the remaining lung open and lowers the chance of a chest infection, and walking a little further every day rebuilds stamina faster than rest. Breathlessness on stairs improves over weeks as the remaining lung adapts. Desk work returns in two to four weeks and heavy lifting after six. Flying waits for the doctor's check. After an open operation or an esophagectomy, the stay and recovery are longer, with eating after an esophagectomy rebuilt over weeks with small meals and a dietitian's plan. Drug treatment after surgery, when planned, starts four to eight weeks later.

How long to stay in Istanbul

Plan for ten to fourteen days after a lung resection.

A published Istanbul lobectomy package with lymph node dissection lists five days in hospital and includes the operation and transfers, with the hotel left out. Staging tests before surgery take a few days. Some are done before you travel. Pathology arrives within a week and is discussed before you fly, and fitness to fly is confirmed with a chest X-ray showing the lung fully expanded, around two weeks after surgery.

What decides the cost

The operation, keyhole, robotic or open surgery, staging tests such as PET-CT and EBUS, nights in hospital, pathology with molecular tests, and treatment before or after surgery set most of the figure.

A quote you can compare names the operation, the staging and the stay, and that figure comes only after a thoracic surgeon reviews your CT, PET-CT and biopsy. The review costs nothing.

Arranging the trip

CT and PET-CT images, a biopsy report and breathing tests, shared on WhatsApp, open the review, and the coordinator who replies stays with you through staging, surgery and the treatment that follows. The team speaks English, Arabic, French, Russian, Serbian, Romanian and Spanish, and interpreters cover other languages. One relative stays overnight on the companion bed. Others stay nearby. The international office books the hotel, sends the visa invitation letter ten days before travel and arranges transfers, and halal, vegetarian and diabetic meals, a prayer room and a female physician on request are available.

Once you are back home

Our hospital gives immunotherapy, chemotherapy and radiotherapy on the same site, or continued with your oncologist at home. CT scans every six months for two years, then yearly. They watch for recurrence.

Fever, increasing breathlessness, chest pain, coughing up blood, or redness and fluid at the drain site. Each needs a doctor the same day.

Thoracic oncology surgery FAQ