Compared with open esophagectomy, the minimally invasive route puts the body through less surgical trauma. Blood loss is lower and lung complications are fewer, especially in the weeks right after the operation. Long-term cancer outcomes in the trials so far are comparable, so the decision comes down to the tumour, the patient’s overall health and how experienced the surgeon is with the technique.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, explains how the two approaches compare for cancers of the food pipe. “It’s a big operation however you do it. What the keyhole route changes is the chest wall, which isn’t cut open, and you see that in the first few weeks, with fewer chest infections and an easier recovery. None of that counts if the cancer isn’t cleared as well, so that’s the first thing we make sure of.”

Both operations do the same job. The diseased part of the food pipe comes out, and what’s left gets joined to the stomach. How the surgeon reaches it is what differs.

Open: Big cuts, one in the chest and one in the abdomen. The surgeon works through them by hand.

Keyhole: A few small cuts instead. A camera and long, thin instruments go in through openings in the chest and belly.

Hybrid: Part keyhole, part open. Some surgeons do the abdomen by keyhole and the chest the open way.

Robotic: The same small cuts, with a robot holding the instruments and giving the surgeon a magnified 3D view.

What doesn’t change: The tumour and the nearby lymph nodes come out whichever route is used. The stomach is shaped into a tube and lifted up to take the place of the food pipe. If you’re curious how keyhole operations work in general, our page on laparoscopic cancer surgery explains it.

Keyhole isn’t for everyone.

Large or invasive tumours: A tumour pressing on nearby structures can call for the room and control that open surgery gives.

Earlier surgery: Scarring from a previous chest or abdominal operation can make keyhole surgery harder to do safely.

Changing course: Sometimes the surgeon starts with keyhole and moves to open because carrying on isn’t safe. That’s judgement, not a failed operation.

Experience: It’s a demanding operation to do by keyhole, and results are best where the team does it regularly. You can read about the surgeon’s background on our expertise page.

The three approaches differ mainly in the size of the cut and in how the surgeon sees and works inside the chest. Open thoracotomy uses one larger incision. VATS uses small cuts, a camera and long instruments, and RATS adds a robotic console with a three dimensional view. All three are used for lung cancer resections, including lobectomy. The right choice depends on the tumour, the patient’s health and the team’s experience.

According to Dr. Sandeep Nayak, a surgical oncologist in India, the choice between VATS vs RATS and open thoracotomy for lung cancer surgery depends on the tumour. “The approach is chosen to suit the tumour. Each one can remove a lung cancer completely when it is used in the right patient. Smaller cuts usually mean less pain and a quicker recovery. Some tumours still need an open operation to be removed safely. The route is only a means to the goal, and the goal is complete removal 

All three reach the lung through the chest wall, but the access and the tools differ.

Open thoracotomy: One larger incision between the ribs, with the ribs spread for access. The surgeon works looking directly at the lung.

VATS: A few small cuts between the ribs. A camera and long instruments are used, and the surgeon works from a screen. The full name is video-assisted thoracoscopic surgery.

RATS: Small cuts again, this time with a robotic console. The surgeon controls the instruments from the console and sees a magnified three dimensional view. The instruments bend and rotate more freely than straight VATS tools.

What they can treat: All three can be used for lobectomy, segmentectomy and wedge resection, depending on the tumour.

The same operation by a different route: In principle the tumour and the lymph nodes are removed in each case. Only the way in changes. Our page on lung cancer treatment covers the operations used.

The table sets out the main differences side by side.

VATS vs open: Trials found less pain and better quality of life after VATS, and long term survival wasn’t significantly different. Our blog on VATS surgery for lung cancer explains how it works.

RATS vs VATS: A pooled analysis of randomised trials found equivalent cancer and complication outcomes. RATS showed less blood loss and more lymph nodes removed, but that hasn’t translated into better survival.

Cost: Robotic systems generally cost more to buy and run, so RATS usually costs more.

Switching during surgery: Any keyhole operation can be changed to open surgery if it isn’t safe to continue. It’s a safety step, not a failure.

The choice is made case by case, using a few clear points.

Tumour size and position: Small tumours away from the main blood vessels suit keyhole surgery. Large tumours, or those close to the main vessels or airway, can make open surgery safer.

Spread: Tumours growing into the chest wall or nearby structures, or heavily involved lymph nodes, may need an open operation.

Earlier chest surgery or infection: Heavy scarring inside the chest can make keyhole access difficult.

Lung function and general health: Fitness for anaesthesia and surgery shapes how much lung can be removed and by which route. Our blog on whether lung cancer surgery removes the whole lung explains how much may come out.

Team experience and availability: Results depend on how often the team performs the chosen approach. Robotic surgery is available only at some centres.

Key Takeaways

• Open thoracotomy uses one larger incision. VATS and RATS use small cuts with a camera, and RATS adds a robotic console.
• Compared with open surgery, VATS usually means less pain and a quicker recovery, without worse cancer outcomes in suitable patients.
• Pooled randomised trials found RATS and VATS to be equivalent for cancer and complication outcomes, and RATS usually costs more.
• Some tumours still need open surgery. The right approach depends on the tumour, the patient’s health and the team’s experience, and is best discussed with a specialist.

References

1. PubMed — Long-term survival from a randomized controlled trial of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer: https://pubmed.ncbi.nlm.nih.gov/39873729/
2. National Center for Biotechnology Information — Robotic vs. video-assisted thoracoscopic surgery for resectable non-small cell lung cancer: a systematic review and meta-analysis of randomized controlled trials: https://pmc.ncbi.nlm.nih.gov/articles/PMC13460117/

Disclaimer: This blog is for informational and educational purposes only and is not a substitute for professional medical advice or diagnosis.

Most people hear “lung cancer surgery” and picture one operation. There are really three common ones, and what separates them is simple: how much lung leaves the body. A lobectomy takes a whole lobe. A segmentectomy takes a smaller piece of a lobe, a self-contained section with its own airway and blood supply. A wedge resection takes a small chunk around the tumour and doesn’t follow any of the lung’s natural lines.

Dr. Sandeep Nayak, a surgical oncologist in India, puts it this way: the operation should be cut to fit the tumour and the lungs, not the other way round. He won’t suggest a plan until the scans, the lymph node findings and the breathing tests are all on the table together.”

When the cancer hasn’t left the lung, surgery is usually the first option on the table in lung cancer treatment. Think of the lung as a tree. A lobectomy takes off a whole major branch. A segmentectomy prunes a smaller limb at the point where it joins. A wedge resection just cuts out the damaged part without worrying about where the branches split.

A lobectomy is the long-standing standard. The right lung has three lobes and the left has two, and the surgeon removes the one that holds the tumour. It’s the biggest of the three, and for years it was the default for any operable early cancer.

A segmentectomy is trickier to perform. The surgeon has to find that segment’s own bronchus, artery and vein, divide them one by one, and lift the segment out cleanly. The reward is that more healthy lung stays behind.

A wedge resection is the quickest and smallest. A stapling device cuts a wedge out and seals the edge as it goes. The catch is that nothing guarantees a generous rim of healthy tissue, so it depends heavily on where the tumour sits.

In all three, nearby lymph nodes are usually sampled or removed. What they show can change what happens next, so the surgeon doesn’t skip them.

And the technique is a separate question from the extent. Open surgery, VATS keyhole surgery or a robot can be used for any of the three.

Picture a typical case. A patient in their sixties has a 1.5 cm nodule near the outer edge of one lung, the lymph nodes look clear, and breathing tests are on the weak side after years of smoking. For that person, a segmentectomy often makes more sense than a lobectomy. Change one detail, say the nodule is 3.5 cm and close to the main airway, and the answer flips.

So what actually tips the decision?

Size and position matter most. Small tumours of around 2 cm or less in the outer lung are the best candidates for a smaller operation. Large ones, or ones near the centre of the chest, usually aren’t.

Lymph nodes come next. If they look involved on a scan, or turn out to be involved during surgery, the surgeon will often move to a lobectomy and clear the nodes more thoroughly.

The look of the tumour on CT counts too. A hazy “ground glass” appearance often means slow growth, which can justify taking less lung.

Then there’s the patient. Weak breathing reserve, heart trouble or other illness can make a smaller operation the safer choice, even when a lobectomy would otherwise be on the cards.

The research backs this up for carefully chosen cases. A large randomised trial looked at tumours up to 2 cm in the outer lung with clear nodes, and patients who had a smaller resection did about as well on disease-free survival as those who had a lobectomy.

Whether surgery can cure the cancer at all depends on stage, which our guide on whether lung cancer can be cured explains.

How you recover depends on two things: how much lung came out, and how it was done. Robotic surgery and other keyhole methods mean smaller cuts and usually an easier few weeks than an open chest operation.

Wedge resection has a narrow but real role. It works for very small nodules near the edge of the lung, for cases where the surgeon needs tissue to confirm what the nodule actually is, and for patients too frail for anything bigger.

The margin is the whole story here. Take less tissue and you need a clear rim of healthy lung around the tumour. If that rim comes back too thin, the surgeon may extend the operation to a segmentectomy or lobectomy on the spot, which is why you’ll be asked to consent to that possibility beforehand.

When researchers went back to the data from the same North American trial, wedge resection came out worse on survival than either segmentectomy or lobectomy. The two bigger operations weren’t meaningfully different from each other. That’s a big reason surgeons lean toward segmentectomy over a wedge when a smaller operation is on the table and the patient can handle it.

Key Takeaways

• Lobectomy takes a whole lobe, segmentectomy takes one defined section of it, and wedge resection cuts out a small piece without following the lung’s structure.
• Size, position, lymph nodes and breathing ability do most of the work when choosing between lobectomy vs segmentectomy.
• For small tumours in the outer lung with clear nodes, smaller operations have held up well in trials.
• Wedge resection is only as good as its margin, so it’s reserved for carefully chosen patients.
• No one decides this from a single scan. The oncology team looks at the scans, the biopsy and the breathing tests together.

References

1. NHS. Treatment for lung cancer (NHS Health A to Z). https://www.nhs.uk/conditions/lung-cancer/treatment
2. Altorki N, Wang X, Kozono D, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023;388(6):489-498. https://pubmed.ncbi.nlm.nih.gov/36780674/

Disclaimer: This blog is for informational and educational purposes only and is not a substitute for professional medical advice or diagnosis.

Surgery is the first and main treatment for most oral cavity cancers, including cancer of the tongue. Radiation usually comes later, after the operation, if the pathology report points to a higher risk, and it takes the lead only when surgery isn’t an option. Speech and swallowing are affected because the tongue is central to both. How much changes depends on how much of it is removed, which part, and whether it’s rebuilt.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, talks patients through what to expect after a glossectomy. “The first question I get before tongue surgery is almost always the same: will I be able to talk and eat afterwards? With a small tumour, usually yes, with only a mild and brief change. If a bigger part has to go, the road is longer and rehab matters a lot. We plan the surgery and the recovery together.”

 

That depends on the tumour: how big it is, how deep, and where it sits. The surgeon takes the cancer plus a small rim of healthy tissue around it, and tries not to take more than that.

Partial glossectomy: Most people with a small tumour on the side of the tongue need only this. A piece comes out and the rest of the tongue stays. Some of these small tumours can be reached through the mouth with robotic help, and our page on trans oral robotic surgery covers where that’s used.

Hemiglossectomy: Half the tongue. This is for larger or deeper tumours.

Total glossectomy: The whole tongue, or nearly all of it. Rare, and kept for advanced cancers.

The neck: Tongue cancer often spreads to the lymph nodes in the neck, so the surgeon usually clears those during the same operation.

Rebuilding: If a big part is taken, skin and tissue from the forearm or thigh can be used to build the tongue back up.

Almost every sound you make involves the tongue. So yes, speech changes. How much is the real question.

Small removals: Many people notice very little. Some are a bit slurred for a short while, and then it settles.

Bigger removals: Clarity can drop. Sounds like t, d, l and s need the tip of the tongue to touch the roof of the mouth, so those suffer first.

Straight after surgery: Swelling makes everyone sound muffled for the first few days. It passes.

A rebuilt tongue: The tissue used to rebuild it gives the tongue enough bulk to reach the palate, and that helps with clearer sounds.

Speech therapy: This starts early. Exercises, practice, patience. Over weeks and months most people get clearer, even if it doesn’t sound exactly as it once did. Speech is a large part of head and neck cancer care, and our page on head and neck cancer treatment covers that.

For most oral cavity cancers, surgery is the first and main treatment, and radiation therapy is added afterwards when the pathology report shows a higher risk of the cancer returning. Radiation becomes the main option when an operation isn’t possible or safe. The right sequence depends on the stage, the site in the mouth and the patient’s overall health.

According to Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, explains how the two are weighed when planning oral cancer treatment. “Patients often ask whether radiation can simply replace the operation. For most cancers of the mouth, surgery goes first. It removes the tumour, and the report afterwards tells us how far the disease had gone. Radiation is added where that report calls for it. Where surgery isn’t safe or possible, radiation leads.” 

The oral cancer surgery vs radiation question comes up at almost every first consultation. In most cases the operation goes first, for a few good reasons.

Takes out the tumour: Surgery removes the growth along with a rim of healthy tissue around it. When the cancer can be removed safely, that’s the most direct way to deal with it.

Gives a full report: The removed tissue goes to the lab. The report shows how deep the tumour went, whether the edges are clear and whether nerves were involved. Radiation alone can’t tell you any of that.

Checks the neck: Cancers of the mouth often spread to lymph nodes in the neck, so a neck dissection is commonly part of the operation. In suitable cases, Dr. Nayak’s RIA-MIND technique does this through the area below the collarbone, which avoids a visible neck scar. You can read more on our expertise page.

Keeps radiation in hand: Radiation in the same area is usually hard to repeat. There’s value in holding it back for when it’s needed.

Early cancers: For small, early-stage tumours, surgery and radiation therapy may offer comparable outcomes in certain cancers. The choice of treatment depends on the cancer type, tumour location, overall health, and individual treatment goals.

Minimally invasive options: Where the tumour allows it, robotic techniques can be used. Our page on trans oral robotic surgery covers where it’s used, and the one on robotic cancer surgery gives the wider picture. For how these approaches compare on results, see our blog on whether minimally invasive cancer surgery gives the same cure rate as open surgery.

Surgery isn’t always the end of the plan. Often radiation follows.

Higher-risk reports: A larger or deeper tumour, margins that are close or not clear, cancer in the lymph nodes, or nerve involvement. Any of these raises the chance of the cancer coming back.

Stage III and IV: Most patients with these stages are candidates for surgery plus radiation, according to the National Cancer Institute.

Adding chemotherapy: In some cases chemotherapy is given alongside the radiation so the two work better together.

Timing: It usually starts a few weeks after surgery, once the wound has healed. Long delays can reduce the benefit, so planning begins early.

Dental check first: Radiation affects the teeth and jaw, so a dental review comes before it starts.