Lung cancer treatment: When must surgery be performed?
Lung cancer is the third most common cancer in Israel, and the leading cause of death from cancer. Every year, about 2,600 lung cancer patients are diagnosed in Israel, and about 90% of them smoke, who are 20 times more likely to develop the disease than non-smokers.”The reassuring news is that while it is a deadly cancer, the progress made over the last decade in treating it is a revolution. The revolution in surgical treatment has taken place with the transition from an open to a minimally invasive method of treatment. “Yes, radiation therapy has evolved to capabilities that were not there before, today it is a targeted treatment of the tumor itself with minimal damage to the surrounding lung tissue. All of these lead to a real change in the patients’ quality of life and longevity.”

“In the surgical field, we now offer minimally invasive lung resections using video or robotics systems, which recover very quickly. Most patients get out of bed on the day of surgery, and the next day or a few days are discharged home,” explains Prof. Yael Refaeli, director of the Department of Breast Surgery. For heart and chest surgery at Soroka Medical Center.

At what stage do patients meet the surgeon?

Prof. Refaeli: “The treatment is adapted to the stage where the disease is detected. In the early stages of the disease (stage 1-2), there are usually no symptoms and the disease is detected by chance, so the patient is referred to me by a family doctor or lung doctor due to random imaging findings. Checks the available data, evaluates what data is missing to complete the image and recommends further clarification: CT scan, bronchoscopy, or PET CT (imaging test that combines two technologies and is mainly used to diagnose tumors, their location and extent of spread), etc. I, as the person managing the case will be “Which will assist in referrals and appointments for additional specialist physicians, and I will mediate for the patient all the necessary medical clarification before deciding on surgery.”

“Sometimes, further clarification involves diagnostic surgery, the whole purpose of which is to establish the diagnosis and determine the severity of the disease. In this case, my job as a surgeon will be to take tissue for biopsy. There are situations where it is clear that it is a tumor, For a “frozen incision,” wait about 40 minutes while the patient is still on the operating table until the biopsy results return from the pathology lab, then complete the tumor resection to save the patient from further hospitalization and surgery. ”

“In situations where the patient is referred to me because he suffers from symptoms such as shortness of breath, cough with phlegm or even some pain that may have been caused by metastases originating from a healthy tumor, it is usually a condition of advanced, diffuse disease (stage 3-4),” says Prof. ‘Refaeli.

“Every case of a new patient will eventually come up for discussion by a multidisciplinary team” | צילום:
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“At these stages, the solution of surgery is ineffective, so I prefer to refer to an oncologist for further treatment with systemic drugs, chemotherapy, immunotherapeutic drugs or biologics. There are situations where the decision does not depend only on the size of the tumor: Lung disease (COPD and cardiovascular disease. Sometimes there is a situation that even if you want to offer surgery – the patients will not undergo surgery even though they are in the early stages of lung cancer. Also, there is a unique group of patients, who are in a stage we call IIIA. “Different and includes a phase of oncological drugs in order to shrink the tumor, before the operation,” adds Prof. Refaeli.

Who are the physicians involved in making the diagnosis and treatment?


“Each case of a new patient will eventually come up for discussion by a multidisciplinary team, which includes not only a breast surgeon but also an oncologist, radiologist and pulmonologist. Together we discuss each case and determine the best way to treat: systemic, radiation, pre-systemic treatment. “The surgery, or surgery. In extreme cases, when the surgery reveals a more advanced disease than we thought, we recommend systemic, chemotherapy or other complementary treatment.”

What types of lung surgeries are available?

“Today we operate mainly by minimally invasive methods, using video (turcoposcopy) or using a robotic system. As mentioned, there are surgeries that are diagnostic, for example, when a biopsy is required not only of the tumor, but also of lymph nodes or mucous membranes. Tumor resection. In the last ten years we have undergone a revolution in the field of surgery. In the past we used to perform a large operation that included opening the chest. Surgery from which the recovery was long and complex. Today, large surgeries are very rare. .

Another change that the world of breast surgery has undergone is the transition from “large” resections, or resection of the entire lung, to the removal of small tumors while preserving the lung tissue. There are several types of surgery, Prof. Refaeli explains:

  • Peg analysis: it focuses on the findings, ie the tumor, and removes only it
  • Segment surgery: The lung is divided into 20 segments, and during the surgery one of them is removed
  • Lobe resection: This is the most common type of surgery. There are 5 lobes in the body, two in the right lung, three in the left. In surgery we remove the lobe where the tumor is located
  • Lung resection: This is a surgery that is almost no longer performed, as there are good measures that include oncological treatments that we can offer along with resection, to avoid resection of an entire lung. Each lung resection surgery also samples the regional lymph nodes

What does rehabilitation involve after lung surgery?

“The best rehabilitation is to walk, breathe, get out of bed and walk around the ward corridor. In the past we were hospitalized in intensive care after surgery, today patients come straight to the ward and the staff helps move from lying to sitting in bed. Many patients go home the day after surgery. “Best Physiotherapy After Lung Surgery.”

“Pain treatment receives a lot of attention from us. We recommend that patients use painkillers. Neutralization of pain is part of rehabilitation: less pain means better breathing, avoiding complications, reducing stress, pressure and anxiety,” concludes Prof. Refaeli.

It should be emphasized that the choice of possible treatment is for the decision of the therapist who registers the prescription in consultation with the patient. The information As of December 2021. For more information, please contact the attending physician. Service To the public. Served under the auspices of Roche Pharmaceuticals (Israel) Ltd.

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