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.

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.

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.

No two people recover alike. These are the things that shape it.

How big the tumour was: The more tongue that has to come out, the bigger the change.

Where it was: The tip and front mostly change how clearly you speak. The back mostly changes swallowing.

Whether it was rebuilt: And how.

Radiation afterwards: If you need it, it can leave you with a dry mouth and some stiffness, and that makes both speaking and swallowing harder.

The neck operation: In suitable cases, Dr. Nayak’s RIA-MIND approach to neck dissection is designed to cut complications and help function. You can read more on our expertise page.

Rehab: Early therapy and daily practice at home count for a great deal, and they’re as much your job as the surgeon’s.

Where you started from: Your age, your general health, and how you were speaking and eating before.

Key Takeaways

• The tongue plays a vital role in both speech and swallowing, so surgery can affect these functions.

• Smaller tissue removals usually cause milder changes, while larger surgeries may require longer recovery and therapy.

• Surgical planning, reconstruction and rehabilitation help improve speech and swallowing after surgery.

• Ask your care team what to expect based on your tumour and planned surgery.

• To discuss your treatment options, book an appointment or call the clinic at +91 9482202240.

References

National Cancer Institute (NCI) – Head and Neck Cancers: Side Effects and Rehabilitation https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet

 PubMed – Voice Rehabilitation After Tongue Cancer Surgery: A Cohort Study in Indian Population https://pubmed.ncbi.nlm.nih.gov/39559020/

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

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.

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

Stage and size: How big the tumour is, how deep it goes and whether the nodes are involved. Our page on oral cancer treatment covers how the plan changes with stage.

Site in the mouth: The tongue, the lining of the cheek, the gums, the floor of the mouth and the palate each behave a little differently. Cancer that has reached the jaw bone often needs surgery.

Speech, chewing and swallowing: Both options are weighed on how they’ll affect these, and on how the mouth will look afterwards. The NCI notes that the choice is generally guided by expected function and appearance.

General health: Fitness for anaesthesia and for a long recovery matters, as do conditions like diabetes.

The patient’s priorities: Once the options are explained, recovery time, scars and daily life are part of the decision too.

Key Takeaways

• Surgery is the primary treatment for most oral cavity cancers.

• Radiation may be recommended after surgery if the pathology report indicates a higher risk of recurrence.

• Radiation may be the main treatment when surgery is not possible or safe.

• For some early-stage cancers, either surgery or radiation may be an option.

• The treatment plan depends on the cancer stage, location in the mouth and the patient’s overall health.

• To discuss your case, you can book an appointment or contact the clinic at +91 9482202240.

References

1. National Cancer Institute (NCI) – Lip and Oral Cavity Cancer Treatment Explains treatment options for oral cavity cancer, including surgery, radiation therapy, and treatment decisions based on cancer stage. Link: https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq

2. American Cancer Society – Treating Oral Cavity and Oropharyngeal Cancer by Stage Describes how treatment approaches vary by cancer stage and when surgery, radiation, or combined treatments may be considered. Link: https://www.cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer/treating/oral-cavity-options-by-stage.html

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

For most common cancers, minimally invasive surgery cures about as many patients as open surgery does. In colon and rectal cancer, laparoscopic vs open cancer surgery studies show the same survival and recurrence, and patients go home sooner with less pain. Early cervical cancer is the exception. Open radical hysterectomy gave better survival there. So the cancer type, its stage and the surgeon’s experience all matter.

Prof. Dr. Sandeep Nayak, Surgical Oncologist at MACS Clinic, Bangalore, explains how minimally invasive oncology and open surgery are weighed against each other. “Keyhole and robotic surgery suit many cancers. For some, open surgery is still the better operation. Newer doesn’t mean better. What counts is which approach clears that cancer best at that stage. Where results are equal, the gentler approach is usually chosen. Where they aren’t, the better approach is used.” 

For several common cancers, large studies show the two approaches control cancer equally well.

Colon and rectal cancer: Pooled reviews find no significant difference in disease free survival, local recurrence or spread. Short term recovery is better after laparoscopic and robotic surgery.

Surgeon experience: Equal results come from experienced teams. Both laparoscopic and robotic surgery have a steep learning curve, so volume matters.

Recovery: Smaller cuts mean less blood loss, less pain, fewer wound problems and a shorter hospital stay.

Complicated cases: Open surgery is still preferred when the colon is perforated, blocked or bleeding.

Case by case: Which cancers suit the keyhole route is worked out case by case. Our page on laparoscopic cancer surgery covers where it’s used.

Equal results can’t be assumed for every cancer. Early cervical cancer is the clearest example.

Early cervical cancer: In the LACC trial, disease free survival at 4.5 years was 86.0% after minimally invasive radical hysterectomy and 96.5% after open surgery. Overall survival was lower too.

What changed afterwards: Open radical hysterectomy is now widely recommended for early stage cervical cancer.

Difficult tumours: Very bulky tumours, or those pressing on nearby organs, can make an open operation the safer one.

Switching mid operation: A surgeon may convert from keyhole to open if it isn’t safe to continue. That’s sound judgment, not a failed operation.

Further reading: For a wider overview of how these operations are done, see our blog on minimally invasive cancer surgery in India.

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

Stage of the cancer: The stage shapes how much has to be removed, and that decides which approach can do it safely. Our blog on cancer staging and how it determines surgery explains this.

Earlier operations: Scar tissue from previous surgery can make keyhole surgery harder. Sometimes open surgery is the safer route.

General health: Fitness for anaesthesia and a long operation affects which approach is safe.

Team review: Surgical, medical and radiation oncologists often review the case together before the plan is set.

The patient’s priorities: Once the options are explained, recovery time and scars are part of the decision too.

Key Takeaways

• Minimally invasive surgery gives comparable cure rates to open surgery for many common cancers, such as colon and rectal cancer.
• Early cervical cancer is the main exception, where open surgery gave better survival.
• The right approach depends on the cancer, its stage and the surgeon’s experience, so it’s worth asking which option the evidence supports for your case.

To discuss your case, you can contact the clinic at +91 9482202240.

References

1. National Center for Biotechnology Information — Comparing the Perioperative and Oncological Outcomes of Open Versus Minimally Invasive Inguinal Lymphadenectomy in Penile Cancer: A Systematic Review and Meta-Analysis: https://pmc.ncbi.nlm.nih.gov/articles/PMC12468625/
2. National Center for Biotechnology Information — Video Endoscopic Inguinal Lymphadenectomy for Radical Management of Inguinal Nodes in Patients With Penile Squamous Cell Carcinoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC4944619/

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