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Lung cancer surgery

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Lung cancer surgery describes the use of surgical operations in the treatment of lung cancer. It involves the surgical excision of cancer tissue from the lung. It is used mainly in non-small cell lung cancer with the intention of curing the patient.

Patient selection

Not all patients are suitable for operation. The stage, location and cell type are important limiting factors. In addition, patients who are very ill with a poor performance status or who have inadequate pulmonary reserve would be unlikely to survive. Even with careful selection, the overall operative death rate is about 4.4%.[1]

Stage

"Stage" refers to the degree of spread of the cancer.

See non-small cell lung cancer staging

In non-small cell lung cancer, stages IA, IB, IIA, and IIB are suitable for surgical resection.[2]

Pulmonary reserve

Pulmonary reserve is measured by spirometry. If there is no evidence of undue shortness of breath or diffuse parenchymal lung disease, and the FEV1 exceeds 2 litres or 80% of predicted, the patient is fit for pneumonectomy. If the FEV1 exceeds 1.5 litres, the patient is fit for lobectomy.[3]

Types of surgery

  • Lobectomy (removal of a lobe of the lung)[4]
  • Segmentectomy (removal of an anatomic division of a particular lobe of the lung)
  • Pneumonectomy (removal of an entire lung)
  • Wedge resection
  • Sleeve/bronchoplastic resection (removal of an associated tubular section of the associated main bronchial passage during lobectomy with subsequent reconstruction of the bronchial passage)
  • VATS lobectomy (minimally invasive approach to lobectomy that may allow for diminished pain, quicker return to full activity, and diminished hospital costs)[5][6]

References

  1. ^ Strand, TE (Jun 2007). "Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude". Thorax. BMJ Publishing Group Ltd. PMID 17573442. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  2. ^ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest. 111. American College of Chest Physicians: 1710–1717. doi:10.1378/chest.111.6.1710.
  3. ^ Colice, GL (2007). "Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (Suppl. 3): 161S–177S. doi:10.1378/chest.07-1359. PMID 17873167. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  4. ^ Fell, SC (2005). General Thoracic Surgery (sixth ed.). Lippincott Williams & Wilkins. pp. 433–457. ISBN 0-7817-3889-X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ Nicastri DG, Wisnivesky JP, Litle VR; et al. (2008). "Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance". J Thorac Cardiovasc Surg. 135 (3): 642–7. doi:10.1016/j.jtcvs.2007.09.014. PMID 18329487. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ Casali G, Walker WS (2009). "Video-assisted thoracic surgery lobectomy: can we afford it?". Eur J Cardiothorac Surg. 35 (3): 423–8. doi:10.1016/j.ejcts.2008.11.008. PMID 19136272. {{cite journal}}: Unknown parameter |month= ignored (help)


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