— This is about thoracic surgery. What does a specialist in this field treat, exactly?
— Thoracic surgeons address diseases of the thoracic cavity and chest, including malignant tumors. While heart procedures are typically performed by cardiac surgeons, the department conducts unique combined surgeries that use artificial circulation for lung patients when the heart and great vessels are damaged together.
— Which intra-breast cancers are becoming more common among Russians?
— In recent years lung cancer has emerged as the leading cancer for both men and women. Patients are noticeably younger now. Previously most patients were over sixty; today many are in their forties and fifties, and women are affected more frequently.
There are two plausible explanations for this trend. First, early diagnosis has improved and the disease is detected earlier. Second, the overall stress levels in society have risen. Oncologists identify many factors behind cancer development, but stress is a leading contributor in the clinic where this discussion originates.
Among women, stress is thought to play a role as well. It is believed that female sex hormones may influence the development of lung tumors. A menopause-related drop in hormonal protection may contribute to the onset and progression of lung cancer.
— Mediastinal tumors pose a major challenge in thoracic surgery. What tumors are included in this category?
— To understand this issue, it helps to know what the mediastinum is. It is the space between the two pleural sacs, bounded in front by the sternum and costal cartilages and behind by the spine. The mediastinum contains the heart and its large vessels, the trachea, the esophagus, the thymus, diaphragmatic nerves, the thoracic lymphatic duct, and the bronchial tree.
Mediastinal tumors form a broad group that arises from different tissues. They include thymomas, tumors of the thymus, lymphomas from lymph nodes, and teratomas from embryonic tissue. These tumors can develop at any age, but most often appear in people aged thirty to fifty.
— Do mediastinal tumors have distinctive symptoms?
— Yes. Pain is common and may radiate to the neck, shoulder, or between the shoulder blades. Malignant tumors in this area are dangerous because they can invade nearby organs and spread aggressively. Often chemotherapy precedes surgery.
Tumors on the left side of the mediastinum can mimic angina, and this is true for various tumors rather than a single category. In malignant mediastinal lymphomas, when cancer affects the mediastinal lymph nodes, compression symptoms emerge: coughing, breathing and swallowing difficulty, chest pain, skin itching, and night sweats are frequently observed.
— Has neurofibroma appeared in your patient cases? Can you describe this condition?
— Yes, there have been patients with neurofibromas. These are nodules of nerve tissue that commonly occur in the mediastinum. They typically cause pain and functional impairment.
Some patients notice changes in skin sensation or blurred vision. If a tumor presses near the spine and ribs, it can distort the skeletal architecture, leading to chest and back pain. Neurofibromatosis does not respond to chemotherapy or radiation, so surgical removal is required. One case involved a very large neurofibroma completely surrounding the subclavian artery, pressing on the left lung and even contributing to a clot in the left ventricle. That was a demanding procedure.
— Have thymomas been encountered in practice?
— Indeed. Thymomas tend to follow an aggressive course and can spread to lymph nodes, lungs, and the chest wall, so aggressive surgical strategy is used: removing the thymoma along with surrounding fatty tissue from the thymus and anterior mediastinum, with chemoradiation as needed.
— Are there particular symptoms?
— Symptoms depend on tumor type. Some thymomas cause mediastinal compression syndrome, which brings chest pain, a dry cough, and shortness of breath. A sense of tightness around the trachea and large bronchi, as well as respiratory failure, can occur. There may also be venous compression affecting head and upper body drainage, producing facial swelling, headaches, and a sense of fullness. Esophageal compression can cause swallowing difficulties, a feeling of a lump in the throat.
In some patients this tumor is accompanied by myasthenia gravis, a condition with rapid fatigue of striated muscles. Thymoma can also press on the phrenic nerve, which poses serious risks. Later, breathing difficulties can arise.
— What is the surgical approach when nerves are compressed?
— The standard approach is to remove the offending tissue. In a notable Russian case, surgeons reconstructed the phrenic nerve after removing a thymoma that involved the chest wall and caused myasthenia gravis. The patient underwent chemotherapy, but the tumor persisted and involved the phrenic nerve, necessitating resection of the nerve. A segment of the intercostal nerve was used to recreate the phrenic nerve, allowing the diaphragm to continue functioning. The operation occurred during a period of high pandemic activity, in an older patient, and the decision was made to preserve diaphragmatic function rather than leave the nerve unrepaired.
— Which intrathoracic tumors present the greatest surgical difficulty?
— Difficulty hinges on cancer extent, the organs involved, vascular spread, and whether prior chemotherapy, radiation, or immunotherapy has been given. Previous therapies increase adhesions and blur anatomical landmarks, making surgery far more challenging. These procedures require the most experienced surgeons. The tumor can be peripheral, visible through thoracoscopy, or central, directly involving vessels, the bronchi, the pericardium, or the mediastinum. In the former case, minimally invasive approaches like thoracoscopy or robotic-assisted surgery are effective, whereas the latter often needs more extensive intervention. If the patient is not a surgical candidate, treatment shifts toward chemotherapy or radiation.
Elderly patients present a special challenge. This group is often the most difficult in modern medicine because they commonly have cardiovascular disease in addition to cancer. In many cases, heart disease affects more than half of the patients with lung tumors, involving conditions such as coronary artery disease, valve damage, and arterial blockages near the aortic arch and carotids.
— How are such patients treated?
— In some cases both problems are addressed in a single operation, for example removing the tumor and placing a vascular stent. This often requires collaboration with specialists in cardiac surgery, neurosurgery, and esophageal surgery. In other cases, procedures may be staged if the situation allows. Dividing treatment into phases can risk progression of heart disease, so timing is critical. It is essential to keep patients under close supervision, whether in the hospital or at home, to prevent complications such as a myocardial infarction after surgery.
— What about complications after COVID-19? Tracheal stenosis is a concern. How common is this?
— Tracheal stenosis is not limited to COVID-19. Long-term mechanical ventilation for any reason can cause this problem. Car accidents, brain injuries, strokes, diabetes, or serious myasthenia gravis can all necessitate prolonged ventilation. The longer the tube stays in place, the higher the risk of cicatricial narrowing of the trachea. When the lumen shrinks from 2 x 1.5 cm to 2-3 mm, it can be fatal. Patients may experience the sensation of not getting enough air, noisy breathing, or misdiagnosis as asthma, emphysema, or bronchitis. They may undergo inhalation therapy and mucolytics until a crisis occurs that requires thoracic surgery.
— How do thoracic surgeons address this issue?
— There are two main surgical paths. A circular resection removes a segment of the trachea but carries risks of restenosis and may require a tracheostomy. The second option is tracheoplasty, which uses a T-shaped tube to reconstruct the tracheal lumen over several months. This method is reliable, though the process is lengthy.
— What about innovations in your department? What unique techniques have you developed?
— One goal was to improve how respiratory tract tumors are treated, specifically those involving the trachea and bronchi. The traditional method cuts out a piece of airway and sutures the ends together, which carries high complication rates and can require a long hospital stay. A new approach uses a portion of the wall with autopericardial tissue to close the defect after removing a segment. This reduces complications and allows discharge in about a week.
— How many patients have benefited from this method?
— All six surgeons involved reported good results and even filed a patent for the technique. Before this, no one in the country had performed surgery with this method. Several patients were treated thoracoscopically, underscoring the potential of this revolutionary approach. The team continues to refine techniques, broadening the scope of their work and expertise.
[Citations attributed to clinical practice and institutional experience; see related medical literature for comprehensive context]