Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Surgical Management of Lung Cancer

VIEWS: 46 PAGES: 44

									Surgical Management of Lung
           Cancer
     By Michael Shackcloth
• Except for small cell carcinoma of the lung
  it is generally accepted that surgery is the
  most effective therapy for lung carcinoma
  – Kirsch Ann Thorac Surg 1976
  – Mountain CF Sem Oncol 1983
                  History
• 1821 Milton Anthony - deliberately opened the
  chest
• 1909 Meltzer and Auer - intratracheal
  intubation
• 1933 Graham and Singer first pneumonectomy
  for lung cancer
• 1950 Churchill proposed lobectomy was safer
  and as effective cure for lung cancer
        Assessment of Patient

• Fitness for surgery

• Operability of the tumour
The Right Lung
The Left Lung
Bronchial system
Adenocarcinoma
Squamous cell cancer
Large cell Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer


                      IV:    Any T,
                             Any N,
                             M1
                      Synchronous
                      tumours in
                      different lobes are
                      M1
Staging Lung Cancer - bronchoscopy
Staging Lung Cancer - Mediastinoscopy
Staging Lung Cancer - Mediastinotomy
Staging Lung Cancer - Mediastinotomy
Staging Lung Cancer - Thoracoscopy
Thoracotomy
Thoracotomy - Posterolateral
          Fitness for Surgery

• Age

• Pulmonary function

• Cardiovascular function

• Nutritional Status
               Operability
• Diagnosis and stage
• Operations available
• Adjuvant treatment
• Locally advanced disease
• Small cell lung cancer
Fitness for Surgery
                     Age
• Perioperative morbidity increases with age
• Surgery for clinically stage I and II disease
  is as effective for patients over 70 years old
  compared to younger patients
• Age over 80 is not a contraindication to
  lobectomy or wedge resection
• Pneumonectomy is associated with a higher
  mortality risk in the elderly. Age should be
  a factor in deciding suitability for
  pneumonectomy
Pulmonary Function
      Assessment of Operability
•   CT scan
•   Bone scan
•   PET scan
•   Mediastinoscopy
•   Anterior Mediastinotomy
•   VATS
Thoracotomy - Anterolateral
Open lung biopsy
Lung Resection – Pneumonectomy
Lung Resection – Lobectomy (RUL)
Lung Resection – Lobectomy (RUL)
Lung Resection – Other operations

 • Sublobar resections -
      Segmentectomy
      Wedge resection

 • Bronchoplasty / Sleeve lobectomy

 • Carinal resections – 10 to 12% mortality

 •Chest wall resections
Sleeve Resections
Sleeve Resection
Sleeve Resection
Sleeve Resection
Sleeve Resection
Sleeve Resection
Small Cell Lung Cancer
Video Assisted Thoracic Surgery

								
To top