Thoracic Surgery

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Lung Tumour treatments
  • Pulmonary Diseases treatments
  • Pleural Disorders treatments
  • Mediastinal Diseases treatments
  • Chest and Tracheal Disorders treatments

PROCEDURES PERFORMED PER YEAR:

  • 600 surgical operations
  • 1500 bronchoscopy procedures

The Department of Thoracic Surgery at the San Raffaele Hospital is highly specialized in the surgical treatment of lung cancer and is part of the Integrated Center for Lung Cancer Diagnosis and Therapy in cooperation with the Services of Oncology, Pneumology and Radiology. It is a leading Centre for the surgical treatment of tracheal diseases. All senior surgeons are certified by the European Board of Thoracic and Cardiovascular Surgeons. Standardized clinical protocols are applied for the perioperative patient management following the ERAS (Enhanced Recovery After Surgery) guidelines.

The Department carries out clinical research in the development of new surgical techniques to improve the effectiveness of the treatment of oncologic and non-oncologic diseases of the chest.

The staff provides patients with the most modern minimally invasive endoscopic surgical techniques both for the diagnosis and for the treatment of all disorders of the chest.

 

treatmentS

Lung Cancer

The department of thoracic surgery is highly specialised in the surgical treatment of all lung cancers, working in close cooperation with the Oncology and Radiotherapy Units. Patients with suspected lung cancer may benefit from a complete diagnostic programme delivered by a multidisciplinary team composed of thoracic surgeons, oncologists, radiotherapists, pulmonologists, radiologists and all the specialties involved in the disease.

Main Pathologies Treated:

  • Non-small cell lung cancer (NSCLC): Lung cancer represents worldwide one of the major cancer death causes among malignancies both in men and in women. About 95% of all lung cancers are classified as either small or non-small cell lung cancer. Appropriate disease staging is of paramount importance to identify the correct treatment for each patient. Currently, the Tumour-Node-Metastasis (TNM) staging system is used for such purposes.
  • Early-stage disease: About 30% of the patients present an early-stage disease (TNM stage I and II). In these cases, surgical anatomical resection (lobectomy) is the treatment of choice achieving the best survival results. Video-assisted thoracic surgery (VATS) is a minimally invasive approach to the treatment of early stage NSCLC. In high volume centres with significant VATS experience, VATS lobectomy has been reported to decrease surgical morbidity, including perioperative pain, and seems to be particularly useful for those with significant medical comorbidities; moreover, VATS lobectomy is comparable to standard open thoracotomy in terms of oncological efficacy and survival.
  • Advanced-stage disease: Surgical treatment should be considered also in selected patients presenting with advanced disease. For example, in case of chest wall invasion, en-bloc resection may be indicated for both treatment of the disease and palliative relief of pain. Some patients affected by single mediastinal lymph node station metastasis or single treatable distant metastasis may be considered too for surgical treatment after multidisciplinary discussion.

Top Procedures:

  • Minimally invasive lung resection (VATS lobectomy)
  • Bronchial sleeve resections
  • Mediastinal VATS procedure

Tracheal Pathologies

Tracheal diseases may be congenital, inflammatory, tumour, or post-traumatic. A wide option of surgical and bronchoscopy treatments of the tracheal pathologies are available at the Department.

Main Pathologies Treated:

  • Tracheal tumours: Primary tracheal tumours are rare neoplasm presenting with symptoms caused by progressively-worsening airway obstruction. Squamous cell carcinoma and adenoid cystic carcinoma are the two most common variants. Surgical resection is recommended whenever possible; decisions on resectability are based on imaging studies and the expertise of the surgical team.
  • Acquired tracheal stenosis: Aetiology of acquired tracheal stenosis is multifactorial, and can result from previous intubation or tracheostomy, systemic disease, trauma, infection, or idiopathic causes. Currently, tracheal stenosis most frequently results from prolonged intubation or trauma from intubation itself. A range of endoscopic and open therapeutic techniques are available; often, an endoscopic approach in addition to an open procedure is necessary to relieve obstruction.

Top Procedures:

  • Surgical Procedures
    • Tracheal resections and reconstructions
  • Bronchoscopy procedures
    • Tracheobronchial prosthesis
    • Tracheobronchial laser
    • Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA)
    • Electromagnetic Navigation System Endobronchial (ENB)

Mediastinal Pathologies

Mediastinum is the anatomical space between the two pleural cavities. A number of neoplasms can arise in this region. Our Department is highly skilled both in diagnostic workup and surgical treatment of these lesions.

Main Pathologies Treated:

  • Thymic epithelial tumours: Thymoma and thymic carcinoma are the most frequent tumours of the anterior mediastinum. They are low-grade malignant neoplasms, and have a low incidence in the population; about 15% of the patients may have associated systemic autoimmune syndromes including myasthenia gravis. Complete surgical resection, preferentially by means of VATS, is the mainstay of treatment, and is associated with favourable survival results and resolution of associated syndromes’ symptoms.
  • Neurogenic tumours: Neurogenic tumours are the most frequent posterior mediastinal tumours. These tumours are benign in about 80% of cases. In some cases, posterior mediastinal neurogenic tumours may present with spinal canal extension, the so-called dumbbell-type tumours. Surgical resection is always advised because these tumours, left untreated, continue to grow and become symptomatic. Complete resection can be achieved by means of VATS, eventually in cooperation with the neurosurgeon in case of spinal canal invasion.

Pleural Pathologies

Pleural diseases include a wide range of conditions both of benign and malignant nature. Thoracoscopic surgery is useful to obtain definitive diagnosis and treatment of these pathologies.

Main Pathologies Treated:

  • Spontaneous pneumothorax: Spontaneous pneumothorax is the presence of air in the pleural space not caused by a trauma. It can be classified as primary (i.e. without any underlying cause) or secondary. Secondary pneumothorax may be related to several aetiologies, such as pulmonary emphysema, tumours, infections and many others. Among secondary spontaneous pneumothorax causes, we have a long experience in the treatment of catamenial pneumothorax, which may present in women affected by thoracic endometriosis. The management of the disease is conducted in strictly cooperation with gynaecologists.
  • Malignant Pleural Mesothelioma (MPM): MPM is an aggressive tumour of the pleura. It has a poor prognosis if left untreated. Nowadays, the treatment of the disease is multimodal including chemotherapy, radiation therapy, immunotherapy and surgery. Following indications of multidisciplinary disease team, lung-sparing surgery by removal of the parietal and visceral pleura (pleurectomy/decortication) may be indicated in highly selected patients.

Research & University Activity

The Department of Thoracic Surgery is involved both in clinical and basic science research projects in close collaboration with other Departments of the San Raffaele Hospital and with the Department of Biotechnology. The Department is also involved in multi-centre clinical trials such as the surgical treatment of lung cancer by means of Video Assisted Thoracic Surgery, treatment of rare neoplasms and oncological adjuvant therapies for lung cancer.

The Department holds the Residency Program in Thoracic Surgery at the University Vita-Salute San Raffaele. Residents in Thoracic Surgery are involved in all the activities of the Department and they develop, throughout their 5-year formation, a complete surgical training. Thoracic Surgery lessons are given in Medical School, International MD Program, Residency Program in Thoracic Surgery, Nursing School, Dentistry School and Physical Therapy School. All the staff members are University professors or contract professors at the University Vita-Salute San Raffaele and are involved in the academic activities.

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Endobronchial Ultrasound Trans bronchial Needle Biopsy (EBUS-TBNA)  
  • Electromagnetic Navigation System endobronchial (ENB)
  • Video bronchoscopy
  • Auto fluorescence Laser