Thoracic Surgery
Clinical practice
To perform lobectomy, which is the approach we use for the majority of resections, we use a technique called hybrid video-assisted thoracoscopic surgery (hybrid VATS). We make a small thoracic incision of 6 to 7 cm, and perform the operation under thoracoscopic observation without having to cut the ribs or muscles. We believe this is an ideal surgical technique for lung cancer that offers the 3 benefits of being safe, curative, and minimally invasive. In fact, we have achieved a short median postoperative hospital stay of 4 days and a minimal postoperative complication rate. In addition, our safety rate for this operation remains one of the highest in the world, with only 18 deaths occurring within 30 days after surgery (0.2%) out of 9,366 patients during the 13-year period from 2007 to 2020.
Our department has particular expertise in 2 areas of clinical practice. One is segmentectomy for small lung cancer. Lobectomy is the standard surgical treatment for lung cancer, but less extensive segmentectomy is now being performed for small lung cancers, which have been on the rise in recent years. Since 2009, our department has gained the most experience performing segmentectomies of any institution in Japan as a result of our participation in a nationwide clinical trial investigating the efficacy of segmentectomy. Although segmentectomy requires a more precise surgical technique than lobectomy, it is now possible to perform a segmentectomy that both provides radical treatment and preserves lung function, in a shorter operating time than lobectomy. In addition, rapid intraoperative pathological diagnosis to determine tumor grade and extent of disease is important when performing a segmentectomy. This is because the procedure should be switched from segmentectomy to lobectomy if the tumor grade or extent of disease is greater than was expected preoperatively. One feature of NCCH is that we have many pathologists with extensive knowledge of lung cancer. The other area of expertise is multimodal therapy (surgery combined with chemotherapy or radiation) for locally advanced lung cancer (lung cancer that has invaded adjacent organs or metastasized to the mediastinal lymph nodes). NCCH ranks among the top hospitals in Japan for the number of staff specializing in thoracic oncology and radiation oncology, as well as treatment results in these areas. We take every opportunity to perform multimodal therapy incorporating chemotherapy or radiotherapy for patients with locally advanced lung cancer incurable with surgery alone, and have obtained good treatment outcomes through this approach.
Our department strives to improve not only the quality of our medical care, but also the quality of the service we provide to patients. In our outpatient clinic, our 4 staff physicians are each assigned to handle outpatient care 2 to 3 days per week, to make it easier for patients to schedule their appointments at a time convenient for them. In addition, postoperative patients can directly reach their attending physicians through the hospital switchboard if they have any questions; patients who have undergone surgery have also commented that they feel comfortable talking directly with their attending physicians.
