Non small cell lung cancer surgery: Difference between revisions
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{{Non small cell lung cancer}} | {{Non small cell lung cancer}} | ||
{{CMG}}{{AE}}{{MV}} | {{CMG}}{{AE}}{{MV}} | ||
==Overview== | ==Overview== | ||
Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. Common surgical procedures for the treatment of non-small cell lung cancer, include lung resection with [[lobectomy]], lung resection with [[pneumonectomy]] with or without lymph node dissection. The preferred surgical procedure is [[thoracotomy]] with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes and contiguous structures. | |||
Surgery | ==Surgery== | ||
In non-small cell lung cancer, surgical procedure selection will depend on the histology, margins, and size of the tumor.<ref name="pmid22054885">{{cite journal |vauthors=von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT |title=Functional evaluation before lung resection |journal=Clin. Chest Med. |volume=32 |issue=4 |pages=773–82 |year=2011 |pmid=22054885 |doi=10.1016/j.ccm.2011.08.001 |url=}}</ref><ref name="pmid16618956">{{cite journal |vauthors=Smetana GW, Lawrence VA, Cornell JE |title=Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians |journal=Ann. Intern. Med. |volume=144 |issue=8 |pages=581–95 |year=2006 |pmid=16618956 |doi= |url=}}</ref> | |||
*Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. | *Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. | ||
*Common surgical procedures for the treatment of non-small cell lung cancer, include: | *Common surgical procedures for the treatment of non-small cell lung cancer, include: | ||
:*Lung resection with lobectomy | :*Lung resection with [[lobectomy]] | ||
:*Lung resection with pneumonectomy with or without lymph node dissection | :*Lung resection with [[pneumonectomy]] with or without [[lymph node]] dissection | ||
:*The preferred surgical procedure is thoracotomy with removal of the entire lung or lobe (lobectomy) along with regional lymph nodes (peribronchial and | :*The preferred surgical procedure is [[thoracotomy]] with the removal of the entire lung or lobe ([[lobectomy]]) along with regional lymph nodes (peribronchial and perihilar [[lymph node]] dissection) and pathological evaluation. | ||
*If evidence of [[lymph node]] extension of the disease is present | *If evidence of [[lymph node]] extension of the disease is present [[adjuvant chemotherapy]] should be administered. | ||
*Surgical resection is not recommended | *Surgical resection is not recommended for patients with advanced or metastatic non-small cell lung carcinoma. | ||
*Surgical staging of the mediastinum is considered standard if accurate evaluation of the nodal status is needed to determine therapy | *Surgical staging of the [[mediastinum]] is considered standard if accurate evaluation of the nodal status is needed to determine therapy. | ||
*Surgical treatment consists of a thoracotomy with removal of the entire lung or lobe along with regional lymph nodes and contiguous structures | *Surgical treatment consists of a [[thoracotomy]] with removal of the entire lung or lobe along with regional [[lymph nodes]] and contiguous structures. | ||
*Pneumonectomy is used if the tumor involves the main bronchus, extends across a fissure or is located such that wide excision is required. | *[[Pneumonectomy]] is used if the tumor involves the main [[bronchus]], extends across a [[fissure]] or is located such that wide excision is required. | ||
*Survival following ‘curative’ resection is approximately 30% at 5 years and 15% at 10 years. | *Survival following ‘curative’ resection is approximately 30% at 5 years and 15% at 10 years. | ||
*The best results are found in squamous cell carcinoma followed by large-cell carcinoma and the adenocarcinoma. | *The best results are found in squamous cell carcinoma followed by large-cell carcinoma and the [[adenocarcinoma]]. | ||
*If the pathological evaluation of the dissected [[lymph nodes]] is positive to malignant neoplastic cells, the patient should be treated according to the [[Non small cell carcinoma of the lung medical therapy stage III|Stage III]] treatment algorithm. | *If the [[pathological]] evaluation of the dissected [[lymph nodes]] is positive to [[malignant]] neoplastic cells, the patient should be treated according to the [[Non-small cell carcinoma of the lung medical therapy stage III|Stage III]] treatment algorithm. | ||
*If the [[tumor]] is inoperable, [[ | *If the [[tumor]] is inoperable, [[Stereotactic radiosurgery|stereotactic ablative radiation therapy]] should be administered. | ||
==Indications== | ==Indications== | ||
Non small cell lung cancer surgery is usually reserved for patients with the following characteristics:<ref name="pmid22054885">{{cite journal |vauthors=von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT |title=Functional evaluation before lung resection |journal=Clin. Chest Med. |volume=32 |issue=4 |pages=773–82 |year=2011 |pmid=22054885 |doi=10.1016/j.ccm.2011.08.001 |url=}}</ref> | Non-small cell lung cancer surgery is usually reserved for patients with the following characteristics:<ref name="pmid22054885">{{cite journal |vauthors=von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT |title=Functional evaluation before lung resection |journal=Clin. Chest Med. |volume=32 |issue=4 |pages=773–82 |year=2011 |pmid=22054885 |doi=10.1016/j.ccm.2011.08.001 |url=}}</ref> | ||
*Pulmonary function | *Pulmonary function testing | ||
:*Preoperative assessment of FEV1/DLCO | :*Preoperative assessment of FEV1/DLCO | ||
:*FEV1 >2 L (or more than 80%) | :*[[FEV1]] >2 L (or more than 80%) | ||
:*DLCO > 80 | :*[[DLCO]] > 80 | ||
*Exercise testing | *[[Exercise testing]] | ||
:*Successful cutoff of 22 m on the stair climbing test | :*Successful cutoff of 22 m on the stair climbing test | ||
*Fitness for surgery | *Fitness for surgery | ||
:*Evaluation of risk factors, such as: | :*Evaluation of risk factors, such as: | ||
:*Age | :*Age | ||
:*General health status ( | :*General health status (obesity, Karnofsky scale >70) | ||
:*COPD/ | :*[[COPD]]/[[asthma]] | ||
:*Smoking | :*Smoking | ||
:*Other conditions: pulmonary hypertension, heart failure, and metabolic factors | :*Other conditions: pulmonary hypertension, heart failure, and metabolic factors | ||
==Contraindications== | ==Contraindications== | ||
Non small cell lung cancer surgery is usually contraindicated in patients with the following characteristics: | Non small cell lung cancer surgery is usually contraindicated in patients with the following characteristics:<ref name="pmid16618956">{{cite journal |vauthors=Smetana GW, Lawrence VA, Cornell JE |title=Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians |journal=Ann. Intern. Med. |volume=144 |issue=8 |pages=581–95 |year=2006 |pmid=16618956 |doi= |url=}}</ref> | ||
*Non small cell lung cancer extension past the diaphragm | |||
*Non-small cell lung cancer extension past the diaphragm | |||
:*Extrathoracic [[metastases]] | |||
:*[[Metastasis|Metastases]] to [[supraclavicular lymph nodes]] | |||
:*Contralateral mediastinal node [[metastases]] | |||
*Involvement of contralateral hemithorax | *Involvement of contralateral hemithorax | ||
*Invasion | *Invasion of structures of the [[mediastinum]] | ||
:*Involvement of the main [[pulmonary artery]] | |||
*Chest wall invasion | *Chest wall invasion | ||
*No fitness for surgery | *No fitness for surgery | ||
*Hypercapnia (arterial PCO2 greater than 45 mmHg) | *[[Hypercapnia]] (arterial PCO2 greater than 45 mmHg) | ||
*Inadequate exercise testing results ( 22 m on the stair climbing test) | *Inadequate [[exercise testing]] results (22 m on the stair climbing test) | ||
*Presence of oncological emergencies, such as [[superior vena cava syndrome]], malignant [[pleural effusion]], [[cardiac tamponade]], [[vocal cord]] or [[phrenic nerve]] [[paralysis]]. | |||
==Complications== | ==Complications== | ||
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Common complications of non small cell lung cancer surgery, include:<ref name="pmid16618956">{{cite journal |vauthors=Smetana GW, Lawrence VA, Cornell JE |title=Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians |journal=Ann. Intern. Med. |volume=144 |issue=8 |pages=581–95 |year=2006 |pmid=16618956 |doi= |url=}}</ref> | Common complications of non small cell lung cancer surgery, include:<ref name="pmid16618956">{{cite journal |vauthors=Smetana GW, Lawrence VA, Cornell JE |title=Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians |journal=Ann. Intern. Med. |volume=144 |issue=8 |pages=581–95 |year=2006 |pmid=16618956 |doi= |url=}}</ref> | ||
*Atelectasis | *[[Atelectasis]] | ||
*Infection | *[[Infection]] | ||
:*Nosocomial pneumonia | :*[[Nosocomial pneumonia]] | ||
*Prolonged mechanical ventilation | *Prolonged [[mechanical ventilation]] | ||
*[[Respiratory failure]] | |||
*[[Bronchospasm]] | |||
*[[Pulmonary embolism]] | |||
==References== | ==References== | ||
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{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
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[[Category:Surgery]] | |||
Latest revision as of 17:59, 28 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. Common surgical procedures for the treatment of non-small cell lung cancer, include lung resection with lobectomy, lung resection with pneumonectomy with or without lymph node dissection. The preferred surgical procedure is thoracotomy with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes and contiguous structures.
Surgery
In non-small cell lung cancer, surgical procedure selection will depend on the histology, margins, and size of the tumor.[1][2]
- Surgery is the mainstay of therapy for early-stage non-small cell lung cancer.
- Common surgical procedures for the treatment of non-small cell lung cancer, include:
- Lung resection with lobectomy
- Lung resection with pneumonectomy with or without lymph node dissection
- The preferred surgical procedure is thoracotomy with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes (peribronchial and perihilar lymph node dissection) and pathological evaluation.
- If evidence of lymph node extension of the disease is present adjuvant chemotherapy should be administered.
- Surgical resection is not recommended for patients with advanced or metastatic non-small cell lung carcinoma.
- Surgical staging of the mediastinum is considered standard if accurate evaluation of the nodal status is needed to determine therapy.
- Surgical treatment consists of a thoracotomy with removal of the entire lung or lobe along with regional lymph nodes and contiguous structures.
- Pneumonectomy is used if the tumor involves the main bronchus, extends across a fissure or is located such that wide excision is required.
- Survival following ‘curative’ resection is approximately 30% at 5 years and 15% at 10 years.
- The best results are found in squamous cell carcinoma followed by large-cell carcinoma and the adenocarcinoma.
- If the pathological evaluation of the dissected lymph nodes is positive to malignant neoplastic cells, the patient should be treated according to the Stage III treatment algorithm.
- If the tumor is inoperable, stereotactic ablative radiation therapy should be administered.
Indications
Non-small cell lung cancer surgery is usually reserved for patients with the following characteristics:[1]
- Pulmonary function testing
- Successful cutoff of 22 m on the stair climbing test
- Fitness for surgery
Contraindications
Non small cell lung cancer surgery is usually contraindicated in patients with the following characteristics:[2]
- Non-small cell lung cancer extension past the diaphragm
- Extrathoracic metastases
- Metastases to supraclavicular lymph nodes
- Contralateral mediastinal node metastases
- Involvement of contralateral hemithorax
- Invasion of structures of the mediastinum
- Involvement of the main pulmonary artery
- Chest wall invasion
- No fitness for surgery
- Hypercapnia (arterial PCO2 greater than 45 mmHg)
- Inadequate exercise testing results (22 m on the stair climbing test)
- Presence of oncological emergencies, such as superior vena cava syndrome, malignant pleural effusion, cardiac tamponade, vocal cord or phrenic nerve paralysis.
Complications
Common complications of non small cell lung cancer surgery, include:[2]
References
- ↑ 1.0 1.1 von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT (2011). "Functional evaluation before lung resection". Clin. Chest Med. 32 (4): 773–82. doi:10.1016/j.ccm.2011.08.001. PMID 22054885.
- ↑ 2.0 2.1 2.2 Smetana GW, Lawrence VA, Cornell JE (2006). "Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians". Ann. Intern. Med. 144 (8): 581–95. PMID 16618956.