Chest Surgery

Pneumothorax occurs when air escapes from the lung and collects in the pleural space (the thin gap between the lung surface and the chest wall) causing partial or complete lung collapse. It can arise spontaneously in young, tall individuals with small subpleural air blebs (primary spontaneous pneumothorax), or as a consequence of underlying lung disease such as COPD, tuberculosis, or cystic fibrosis (secondary spontaneous pneumothorax). Traumatic pneumothorax, caused by penetrating or blunt chest injury, represents a surgical emergency. Patients typically present with sudden-onset chest pain and breathlessness; in tension pneumothorax, rapid haemodynamic compromise demands immediate needle decompression. First-line management ranges from observation and supplemental oxygen for small, stable episodes to intercostal chest drain insertion for larger collapses. Recurrent or persistent pneumothorax (where the air leak fails to seal spontaneously) requires surgical intervention: VATS pleurodesis or pleurectomy to obliterate the pleural space and prevent further episodes.

Empyema is a condition in which pus accumulates in the pleural space—the area between the lungs and the chest wall—usually due to a bacterial infection. It commonly develops as a complication of pneumonia but can also occur after chest surgery or other infections. Symptoms may include fever, chest pain, cough, breathlessness, and fatigue. Treatment typically involves antibiotics and drainage of the infected fluid, with surgery sometimes required in advanced cases.

An aspergilloma is a dense mass of Aspergillus fungal hyphae, inflammatory cells, and mucus that colonises a pre-existing cavity within the lung (most often a residual cavity left behind by healed tuberculosis, sarcoidosis, or prior abscess). The fungus does not invade lung tissue in immunocompetent individuals; instead it proliferates within the cavity, forming a movable "fungus ball" visible on chest CT as a solid opacity with a surrounding crescent of air (the air-crescent sign). Many patients remain asymptomatic for years, but recurrent or massive haemoptysis which can be caused by erosion of bronchial vessels lining the cavity wall can be severe and occasionally fatal. Antifungal agents like itraconazole or voriconazole have limited penetration into avascular cavities and rarely eradicate established aspergilloma. Surgical resection (most often a lobectomy or segmentectomy) remains the definitive treatment for symptomatic aspergilloma, particularly in patients with good pulmonary reserve, and carries the highest long-term cure rate.

The mediastinum - the central chest compartment bounded by the sternum anteriorly, spine posteriorly, and the lungs on either side is divided into anterior, middle, and posterior zones, each with its own characteristic tumour types. Anterior mediastinal masses include thymomas, teratomas and other germ cell tumours, and thyroid or parathyroid lesions. The middle mediastinum is the site of lymphoma and bronchogenic cysts, while the posterior mediastinum is home to neurogenic tumours such as schwannomas and neurofibromas arising from intercostal nerve roots. Clinical presentation depends heavily on size and location with smaller tumours being often silent, while larger ones compress adjacent structures to cause breathlessness, superior vena cava obstruction, Horner's syndrome, or hoarseness from recurrent laryngeal nerve involvement. Tissue characterisation through CT-guided biopsy or endobronchial ultrasound (EBUS) guides treatment planning; surgical resection, feasible by VATS or robotic access in many cases, offers the most complete and durable outcome across the majority of benign and resectable malignant mediastinal tumours.

Lung cancer is the leading cause of cancer-related mortality worldwide and the most common malignancy managed by thoracic surgeons. It is broadly classified into non-small cell lung cancer (NSCLC) which includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma and small cell lung cancer (SCLC), which behaves more aggressively and is treated primarily with chemotherapy and radiotherapy. Adenocarcinoma, arising predominantly in the peripheral lung parenchyma, has become the most prevalent subtype, particularly among non-smokers and women. Symptoms in early-stage disease are often absent or non-specific ranging from a persistent cough, mild breathlessness, or a shadow noticed incidentally on a chest X-ray which explains why most patients still present at an advanced stage. Surgery remains the cornerstone of curative treatment for early and locally advanced NSCLC, with anatomical lung resection (lobectomy or segmentectomy) the standard of care; VATS and robotic lobectomy now allow most patients to undergo this with minimal trauma and faster return to function.

Oesophageal cancer arises from the mucosal lining of the food pipe and occurs in two principal histological types: squamous cell carcinoma, which predominates in the upper and middle oesophagus and is strongly associated with tobacco use and alcohol, and adenocarcinoma, which develops in the lower oesophagus on a background of chronic gastro-oesophageal reflux disease and Barrett's oesophagus. The cardinal symptom is progressive dysphagia (initially to solids, then liquids) often accompanied by significant weight loss, retrosternal discomfort, and regurgitation. Because the oesophagus has no peritoneal covering and is closely adjacent to major vascular and airway structures, early lymphatic spread is common, and staging must be meticulous. Curative intent treatment for localised disease typically involves neoadjuvant chemoradiotherapy followed by oesophagectomy; Medanta's surgeons perform both open and minimally invasive robotic-assisted oesophagectomy, with the choice guided by tumour location, patient physiology, and oncological staging.