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.
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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
UICC Stage of Lung Cancer IV: Any T, Any N, M1 Synchronous tumours in different lobes are M1
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
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
Assessment of Operability • CT scan • Bone scan • PET scan • Mediastinoscopy • Anterior Mediastinotomy • VATS
Lung Resection – Other operations • Sublobar resections - Segmentectomy • Wedge resection • Bronchoplasty / Sleeve lobectomy • Carinal resections – 10 to 12% mortality • Chest wall resections