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Surgical Aspects in Lung Cancer Management. Mike Poullis CTC Liverpool. Surgical Aspects in Lung Cancer Management. How fit is the patient ? What is the stage, histology, and exact size and location ? Is the patient for Diagnosis Treatment Palliation. Overview. Diagnostic Bronchoscopy

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surgical aspects in lung cancer management1
Surgical Aspects in Lung Cancer Management
  • How fit is the patient ?
  • What is the stage, histology, and exact size and location ?
  • Is the patient for
    • Diagnosis
    • Treatment
    • Palliation
overview
Overview
  • Diagnostic
    • Bronchoscopy
    • VATS
    • Mediasteinoscopy
    • Mediasteinotomy
  • Treatment
    • Wedge
    • Lobectomy
    • Combined wedge and lobectomy
    • Pneumonectomy
  • Palliation
    • Effusions
diagnostic bronchoscopy1
Diagnostic: Bronchoscopy
  • Rigid and flexible scope
  • Biopsy and selective washings
  • Larger samples than flexible scope
  • Exact location
    • Lobectomy
    • Pneumonectomy
    • Unresectable
    • Sleeve
mediasteinoscopy mediasteinotomy
Mediasteinoscopy & Mediasteinotomy

Different

lymph node

stations

mediasteinoscopy mediasteinotomy2
Mediasteinoscopy & Mediasteinotomy
  • Different surgical cuts
diagnostic mediasteinoscopy mediasteinotomy
Diagnostic: Mediasteinoscopy & Mediasteinotomy
  • Diagnoses unresectable disease
  • Eliminate N2 disease from surgical resection
surgical assessment
Surgical Assessment
  • How fit is the patient ?
  • What is the
    • stage,
    • histology,
    • exact size and
    • location ?
how fit is the patient
How Fit Is the Patient ?
  • Performance status
  • Pulmonary function tests
  • Age
  • Medical and surgical conditions
  • What operation do they need
stage
Stage
  • Assuming fit patient
  • Can and should you take it out
  • N2 or N3 disease
  • T4 disease
histology
Histology
  • Eliminate benign disease
    • Beware false negative biopsy
    • Beware scar cancers
  • Eliminate small cell patients
exact size and location
Exact size and location ?

All T1N0 non small cell carcinoma

treatment
Treatment
  • Wedge
  • Lobectomy
  • Combined wedge and lobectomy
  • Pneumonectomy
thoracotomy
Thoracotomy
  • Posterolateral
  • Anterolateral
  • Lateral
  • Mini
  • Muscle sparing
treatment wedge
Treatment: Wedge
  • Small nodules in poor pulmonary function patients
treatment lobectomy
Treatment: Lobectomy
  • Gold standard
  • Left LUL, LLL,
  • Right RUL+/-RML, RLL+/-RML, RML
  • Never RUL and RLL
treatment pneumonectomy
Treatment: Pneumonectomy
  • Extensive tumours only
  • Intrapericardial or extrapericardial
chemotherapy and radiotherapy
Chemotherapy and Radiotherapy
  • Adjuvant
  • Neoadjuvant
  • Down staging
  • Unexpected N2, or positive margins
  • All small cell
small cell
Small Cell
  • Small nodule needle biopsy shows small cell
  • If bone scan, and CT head negative refer
  • If mediasteinoscopy negative then ? Surgical resection
palliation
Palliation
  • Pleural effusions
    • Drainage, and pleurodesis
      • Pleurectomy
      • Talc
      • Noxious chemotherapeutic agent
  • Decortication
    • Removal of tumour mass surrounding lung in pleural space
    • BENIGN DISEASE DIFFERENT