Lung Cancer Surgery Program

About the Program

The Lung Cancer Surgery Program at the Massachusetts General Hospital Division of Thoracic Surgery employs a variety of minimally invasive and advanced surgical approaches, including video-assisted thorascopic surgery (VATS) to treat lung cancer. We have a rich history of clinical innovation in the treatment of thoracic disease—especially the care of lung and esophageal cancers—dating back to the 1930s. The first anatomic segmentectomy for lung cancer was reported by Dr. Churchill in 1939. Our program provides advanced treatment for cancers involving:

• Chest wall
• Lung
• Mesothelioma (lining of the lung and chest wall)
• Trachea

The Division of Thoracic Surgery has board-certified thoracic surgeons with decades of experience to treat patients with all stages of lung cancer. We create an individualized treatment approach for each patient and often work together with physicians from other medical specialties to treat the most challenging patients and conditions.

Expertise in Diagnosing and Staging Thoracic Cancers

Our surgeons, oncologists, radiologists and pathologists are highly specialized. They have unique experience in safely and rapidly diagnosing and staging thoracic cancers. This expert analysis helps each patient’s doctors to tailor an individualized treatment plan. The plan is made on the day of the multidisciplinary visit to determine the best therapy for each patient. Mass General has one of the most experienced programs in the world treating lung cancers with genetic mutations. Appointments are usually scheduled within one week.

Imaging Techniques

We use the most advanced diagnostic imaging tools, including:

• A robust and leading multi-disciplinary lung cancer screening program
• Cardiothoracic (CT) guided fiducial placement for resection of ground-glass nodules
• Dual-energy cat-scan (CT), MRI, PET and nuclear medicine scans
• Molecular diagnostic tests (genetic and mutational analysis)
• Percutaneous CT guided needle aspiration and core biopsies

Diagnostic Procedures

We offer a number of minimally invasive endoscopic procedures to aid in diagnosing thoracic malignancies, such as:

• Bronchoscopy to explore the bronchial passages
• Endobronchial ultrasound (EBUS) to biopsy lymph nodes next to the bronchial passages, avoiding the need for incisions or mediastinoscopy
• Electromagnetic navigational bronchoscopy to biopsy lung nodules or masses that are in the periphery, avoiding the need to introduce needles through the chest
• Esophagoscopy to explore the esophagus
• Mediastinoscopy to explore the middle of the chest, the area between the lungs, generally to biopsy lymph nodes
• Pathology
• VATS to examine and biopsy the mediastinum, pleura (lining of the chest) and lungs

All thoracic specimens are reviewed by pathologists specializing in thoracic pathology. Our pathologists are recognized for their expertise in thoracic pathology, including lung cancers and mesotheliomas. They lecture internationally and receive requests for consultations from around the world. They are experts in preparing and processing specimens for complex genetic and mutational analysis.

Surgical Results

The Center for Outcomes & Patient Safety in Surgery (COMPASS) ensures that surgical data is transparent and accessible for patients. Watch the video to learn about Mass General's outcomes and performance for surgical treatment of lung conditions including lung lobectomy, robotic surgery, transplant surgery and more.

To ensure safe and effective care, the Department of Surgery tracks many performance measures and compares them to national data, including pulmonary resection outcomes, patient ratings of thoracic surgeons and lobectomy for lung cancer outcomes.

View our surgical outcomes compared to national data

Treatment Options

For those thoracic cancer patients whose treatment will involve surgery, chemotherapy, radiation or some combination of all three therapies, our integrated approach offers a unique combination of multidisciplinary care and the most advanced surgical, medical and radiation therapies.

Our leading edge medical therapies include image-guided minimally invasive radiofrequency (RFA), microwave or cryo-ablation for patients for whom major surgery is not appropriate nor desired.

Mass General thoracic surgeons perform the following resections for lung cancer:

• Carinal resection, a specialized technique to remove cancer that involves the part of the airway that marks the start of both lungs. This requires a complex reconstruction to restore airway continuity
• Minimally invasive pulmonary resections, such as lobectomy, segmentectomy and wedge resections (VATS or robotic surgery is performed whenever possible and appropriate)
• Pneumonectomy, as some cancers are so extensive, large or central that the entire lung must be removed. Sophisticated anesthetic and critical care is utilized to ensure the best outcomes after this significant operation
• Resection of superior sulcus tumor (Pancoast’s tumor) and other advanced lung cancers involving the chest wall, great vessels, spine and heart. This is an advanced technique and requires collaborative surgery with expert orthopedists, neurosurgeons and cardiac surgeons to remove lung cancers that are invading adjacent structures
• Sleeve lobectomy, a specialized and advanced technique to remove central lung cancers that saves lung tissue and avoids pneumonectomy (removal of the entire lung)
• Tracheal resection, which resects tumors of the airway such as adenoid cystic carcinoma, squamous cell carcinoma, and mucoepidermoid cancer and reconstructs the trachea. There is a long tradition of airway surgery at Mass General that ensures the most expert evaluation and management of these rare tumors
• Pulmonary metastasectomy, which involves resection of cancers, such as sarcoma or colorectal cancer, that have spread to the lung

Conditions We Treat

• Emphysema
• Empyema
• Interstitial lung disease
• Pleural effusion
• Small lung nodules
• Superior sulcus tumors

Consultations

In addition to the Division of Thoracic Surgery, consultations can also be obtained via the Center for Thoracic Cancers at the Mass General Cancer Center. The lung cancer research program, supported by Mass General thoracic surgery, is a multifaceted effort designed to understand thoracic cancer biology, discover novel agents and improve treatment.

Patient Care

Mass General is among the first to create a multidisciplinary thoracic oncology clinic. Our team approach ensures that each patient benefits from an individualized, coordinated treatment plan involving thoracic oncology experts from a wide array of specialties, including:

• Nurse practitioners and oncology nurse
• Radiologists and pathologists
• Respiratory therapists and physical therapist
• Social workers and caseworkers, all of whom work exclusively to treat patients with thoracic cancers
• Thoracic surgeons, medical oncologists and radiation oncologists

Our clinicians work together with the patient and their primary care physician to create a coordinated treatment plan for all aspects of care. We work with the patient and their referring physician throughout treatment to ensure the best possible outcome.

Innovative Approaches to Cancer Treatment

Our program is a national leader in the treatment of thoracic cancers. We were the first to pioneer several of the surgical procedures and radiation therapies, and targeted therapies used to treat these cancers, and we continue to advance the field of cancer medicine with new techniques and research. We treat thousands of patients annually, and studies show that such .

Specialization also improves outcomes. Among our highly specialized services is the Francis H. Burr Proton Therapy Center, the Northeast’s only proton radiation facility that offers precisely-targeted radiation that eliminates tumors while reducing damage to healthy tissue. This therapy may be used for patients with certain thoracic cancers.

Striving for Better Therapies

We offer patients a multifaceted, individualized approach to care, including:

• A personalized treatment plan created and coordinated by a team of specialists in thoracic oncology
• Access to the most advanced surgical, radiation and medical therapies
• Novel cancer treatments through clinical trials
• Sophisticated and timely diagnostics
• Specialized nursing care and support services for patients and families

We are one of the nation’s foremost centers for research on thoracic cancers. Access to the latest research allows us to bring promising new treatments to patients as quickly as possible. Some of our current trials include:

• Enhancing standard chemotherapy by modifying chemotherapy resistance
• Immunotherapy to treat advanced or recurrent lung cancer
• Novel therapeutics that inhibit epidermal growth factor receptor, a molecule on a tumor cell membrane that magnifies tumor growth
• Research into the genetics of lung and esophageal cancers in families to explore how genetic differences affect treatment
• "Smart drugs" that limit tumor cell growth and that can be tailored for individualized treatment for each patient