1 / 38

Surgical Management of Lung Cancer

Surgical Management of Lung Cancer. Mike Poullis CTC Liverpool. Surgical Management of Lung Cancer. Is the patient for Diagnosis Treatment Palliation How fit is the patient ? What is the stage, histology, and exact size and location ? Remember NOT ALL PATIENTS HAVE PROVEN LUNG CANCER.

Download Presentation

Surgical Management of Lung Cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Surgical Management of Lung Cancer Mike Poullis CTC Liverpool

  2. Surgical Management of Lung Cancer • Is the patient for • Diagnosis • Treatment • Palliation • How fit is the patient ? • What is the stage, histology, and exact size and location ? • Remember NOT ALL PATIENTS HAVE PROVEN LUNG CANCER

  3. Overview • Diagnostic (Full Hx and examination 1st ) • CXR • CT • PET • Bronchoscopy • VATS • Mediasteinoscopy • Mediasteinotomy • Treatment • Wedge • Lobectomy • Combined wedge and lobectomy • Pneumonectomy • Palliation • Effusions

  4. Diagnostic Tests

  5. CXR • Previous CXR • Bony erosion if has chest pain • Rate of growth • Cardiac Status • Physiological status

  6. CT • T Stage • Lobectomy • Pneumonectomy • N Stage • ? Need mediastinoscopy or mediasteinotomy • M stage • Liver • Adrenals • Other Nodules, Bronchiectasis, Previous CABG, Cardiac, Vascular

  7. PET • Tumour • >1cm • Beware Carcinoid and alveolar cell carcinoma • Mediastinum • If –Ve then probably normal • If +Ve then needs biopsy • Metastasis not brain or heart

  8. PET +Ve -Ve

  9. Diagnostic: Bronchoscopy

  10. Diagnostic: Bronchoscopy • Rigid and flexible scope • Biopsy and selective washings • Larger samples than flexible scope • Exact location • Lobectomy • Pneumonectomy • Unresectable • Sleeve

  11. Diagnostic: Bronchoscopy

  12. Diagnostic: VATS

  13. Diagnostic: VATS (Video Assisted Thoracic Surgery) • Diagnosis of pleural disease

  14. VATS

  15. Mediasteinoscopy & Mediasteinotomy Different lymph node stations

  16. Mediasteinoscopy & Mediasteinotomy • Diagnosis of unresectable disease • Eliminate N2 disease from surgical resection

  17. Mediasteinoscopy & Mediasteinotomy • Different surgical cuts

  18. Mediasteinoscopy & Mediasteinotomy

  19. Mediasteinoscopy & Mediasteinotomy

  20. Treatment

  21. Surgical Assessment • How fit is the patient ? • What is the • stage, • histology, • exact size and • location ? • Basically is the patient fit enough for the operation you think they need ?

  22. How Fit Is the Patient ? • Performance status • Pulmonary function tests • Age • Medical and surgical conditions • What operation do they need

  23. Stage • Assuming fit patient • Can and should you take it out • N2 or N3 disease • T4 disease

  24. Histology • Eliminate benign disease • Beware false negative biopsy • Beware scar cancers • Eliminate small cell patients

  25. Exact size and location ? All T1N0 non small cell carcinoma

  26. Treatment • Wedge • Lobectomy • Combined wedge and lobectomy • Pneumonectomy

  27. Thoracotomy • Posterolateral • Anterolateral • Anterior • Posterior • Lateral • Mini • Muscle sparing

  28. Incision

  29. Treatment: Wedge

  30. Treatment: Wedge • Small nodules in poor pulmonary function patients

  31. Treatment: Lobectomy • Gold standard • Left LUL, LLL, • Right RUL+/-RML, RLL+/-RML, RML • Never RUL and RLL

  32. Treatment: Lobectomy

  33. Treatment: Pneumonectomy • Extensive tumours only • Intrapericardial or extrapericardial

  34. Outcomes After Surgery

  35. Chemotherapy and Radiotherapy • Adjuvant • Neoadjuvant • Down staging • Unexpected N2, or positive margins • All small cell • NICE recommends referring all postoperative lung cancer patients

  36. Small Cell • Small nodule needle biopsy shows small cell • If bone scan, and CT head negative refer • If mediasteinoscopy negative then ? Surgical resection

  37. Palliation • Pleural effusions • Drainage, and pleurodesis • Pleurectomy • Talc • Noxious chemotherapeutic agent • Decortication • Removal of tumour mass surrounding lung in pleural space • BENIGN DISEASE DIFFERENT

  38. Any Questions ?

More Related