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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.

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Surgical Management of Lung Cancer


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    1. Surgical Management of Lung Cancer By Michael Shackcloth

    2. 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

    3. 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

    4. Assessment of Patient • Fitness for surgery • Operability of the tumour

    5. The Right Lung

    6. The Left Lung

    7. Bronchial system

    8. Adenocarcinoma

    9. Squamous cell cancer

    10. Large cell Cancer

    11. UICC Stage of Lung Cancer

    12. UICC Stage of Lung Cancer

    13. UICC Stage of Lung Cancer

    14. UICC Stage of Lung Cancer

    15. UICC Stage of Lung Cancer

    16. UICC Stage of Lung Cancer

    17. UICC Stage of Lung Cancer IV: Any T, Any N, M1 Synchronous tumours in different lobes are M1

    18. Staging Lung Cancer - bronchoscopy

    19. Staging Lung Cancer - Mediastinoscopy

    20. Staging Lung Cancer - Mediastinotomy

    21. Staging Lung Cancer - Mediastinotomy

    22. Staging Lung Cancer - Thoracoscopy

    23. Thoracotomy

    24. Thoracotomy - Posterolateral

    25. Fitness for Surgery • Age • Pulmonary function • Cardiovascular function • Nutritional Status

    26. Operability • Diagnosis and stage • Operations available • Adjuvant treatment • Locally advanced disease • Small cell lung cancer

    27. Fitness for Surgery

    28. 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

    29. Pulmonary Function

    30. Assessment of Operability • CT scan • Bone scan • PET scan • Mediastinoscopy • Anterior Mediastinotomy • VATS

    31. Thoracotomy - Anterolateral

    32. Open lung biopsy

    33. Lung Resection – Pneumonectomy

    34. Lung Resection – Lobectomy (RUL)

    35. Lung Resection – Lobectomy (RUL)

    36. Lung Resection – Other operations • Sublobar resections - Segmentectomy • Wedge resection • Bronchoplasty / Sleeve lobectomy • Carinal resections – 10 to 12% mortality • Chest wall resections

    37. Sleeve Resections

    38. Sleeve Resection

    39. Sleeve Resection

    40. Sleeve Resection

    41. Sleeve Resection

    42. Sleeve Resection

    43. Small Cell Lung Cancer

    44. Video Assisted Thoracic Surgery