Thoracotomy

The most common reason for opening the chest is to remove a cancer of the lung. There are 168,000 new cases of
lung cancer each year with a rising death rate. It is the most common cancer death in men and women. This statistic is
even more dramatic when we realize that only 25% of these patients reach a surgeon in time. This is because
carcinoma of the lung is the most aggressive type of cancer and, before major symptoms occur, the disease has
commonly spread beyond the lung and thus out of the realm of surgical success.

Anatomy and Physiology

The bony skeleton of the thorax, which surround the contents, is made up of
The sternum (breast bone)
Ribs
Costal cartilages. The rib like pieces of cartilage that extend from the ribs to the sternum
The thoracic spine

The bones are held together by muscles and ligaments. The top of the thorax is an open passage (thoracic inlet) to the
structures in the neck. The bottom of the thorax is the diaphragm. With each breath (inspiration), the ribs rise up slightly
to expand the chest, the diaphragm moves down toward the abdomen and air enters the lungs. The reverse occurs with
expiration. The ribs move down and the diaphragm moves upward to expel the gases in the lungs
The thorax primarily contains the heart and lungs. The anatomy related to the heart can be seen under cardiac
catheterization and coronary artery bypass surgery. The lungs are the organs of respiration and

Are divided on the right side into three lobes and on the left into two (Figure 1)

Figure 1. Anatomy of the lungs showing the

various lobes on the right and left side.