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{{Lung cancer}}
{{Lung cancer}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., {{CZ}}
{{CMG}}; {{AE}} {{SH}}


==Overview==
==Overview==
Lung cancer surgery involves the surgical excision of cancer tissue from the lung. It involves the surgical excision of cancer tissue from the lung. It is used mainly in [[non-small cell lung cancer]] with the intention of curing the patient.
Lung cancer [[surgery]] involves the [[Excision|surgical excision]] of the [[Cancer|cancerous]] [[Tissue (biology)|tissue]]. It is used mainly in [[non-small cell lung cancer]] with the intention of [[Cure|curing]] the [[patient]].
 
==Pre-operative Evaluation==
 
If investigations confirm lung cancer, CT scan and often [[positron emission tomography]] (PET) are used to determine whether the disease is localised and amenable to surgery or whether it has spread to the point where it cannot be cured surgically.
 
[[Blood test]]s and [[spirometry]] (lung function testing) are also necessary to assess whether the patient is well enough to be operated on. If spirometry reveals poor respiratory reserve (often due to [[chronic obstructive pulmonary disease]]), surgery may be contraindicated.
 
Surgery itself has an operative death rate of about 4.4%, depending on the patient's lung function and other risk factors.<ref name="Strand">{{cite journal | last =Strand | first =TE | coauthors =Rostad H, Damhuis RA, Norstein J  | title =Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude | journal =Thorax | publisher =BMJ Publishing Group Ltd. | date =Jun 2007 | pmid =17573442 }}</ref> Surgery is usually only an option in non-small cell lung carcinoma limited to one lung, up to stage IIIA. This is assessed with medical imaging ([[computed tomography]], [[positron emission tomography]]). A sufficient pre-operative respiratory reserve must be present to allow adequate lung function after the tissue is removed.
 
=== Pulmonary Reserve ===
The [[American College of Chest Physicians]] established [[clinical practice guideline]]s for the physiologic evaluation of patients with lung cancer being considered for resectional surgery.<ref name="pmid23649437">{{cite journal| author=Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ| title=Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e166S-90S | pmid=23649437 | doi=10.1378/chest.12-2395 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649437  }} </ref> The preoperative physiologic assessment should include a cardiac evaluation and [[spirometry]] to measure the FEV1 and carbon monoxide diffusion capacity (DLCO). Depending on these results the patients can be stratified into different risk groups and further testing may be required or surgery can be initiated. Pulmonary reserve is measured by [[spirometry]]. The minimum [[forced vital capacity]] (FVC) for [[pneumonectomy]] in men is 2 [[liter]]s. The minimum for lobectomy is 1.5 liters. In women, the minimum FVC values for pneumonectomy and lobectomy are 1.75 liters and 1.25 liters respectively.<ref name="Schirren">{{cite journal | last =Schirren | first =J | authorlink = | coauthors =Krysa S, Trainer S et al.  | title =Surgical treatment and results. Carcinoma of the lung | journal =The European Respiratory Monograph | volume =1 | issue =1 | pages =212-240 | publisher = | date =1995 | url = | doi = | id = | accessdate = }}</ref>


==Surgery==
==Surgery==
Procedures include [[wedge resection (lung)|wedge resection]] (removal of part of a lobe), [[lobectomy (lung)|lobectomy]] (one lobe), bilobectomy (two lobes) or [[pneumonectomy]] (whole lung). In patients with adequate respiratory reserve, lobectomy is the preferred option, as this minimizes the chance of local recurrence. If the patient does not have enough functional lung for this, wedge resection may be performed.<ref name="El-Sherif">{{cite journal | last =El-Sherif | first =A | coauthors =Gooding WE, Santos R et al. | title =Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis | journal =Annals of Thoracic Surgery | volume =82 | issue =2 | pages =408–415 | date =Aug 2006 | pmid =16863738 }}</ref> Radioactive [[iodine]] [[brachytherapy]] at the margins of wedge excision may reduce recurrence to that of lobectomy.<ref name="Fernando">{{cite journal | last =Fernando | first =HC | coauthors =Santos RS, Benfield JR et al. | title =Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer | journal =Journal of Thoracic and Cardiovascular Surgery |volume =129 | issue =2 | pages =261–267 | date =Feb 2005 | pmid =15678034 }}</ref>
*[[Surgery]] is the best treatment option for [[Patient|patients]] with [[Resection|resectable]] [[Tumor|tumors]].
 
*The feasibility of [[surgery]] depends on the [[Cancer staging|stage]] of lung cancer at the time of [[diagnosis]].
Also, many times during lung cancer surgery, the doctor will remove some of the [[lymph nodes]] to test for cancer. If the lymph nodes test positive for cancer then that is indicative of the disease spreading beyond the lung. There will most likely be subsequent treatments to help eliminate the remaining cancer.
*The [[Surgery|surgical]] [[Procedure|procedures]] for lung cancer include:<ref name="El-Sherif">{{cite journal | last =El-Sherif | first =A | coauthors =Gooding WE, Santos R et al. | title =Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis | journal =Annals of Thoracic Surgery | volume =82 | issue =2 | pages =408–415 | date =Aug 2006 | pmid =16863738 }}</ref><ref name="Fernando">{{cite journal | last =Fernando | first =HC | coauthors =Santos RS, Benfield JR et al. | title =Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer | journal =Journal of Thoracic and Cardiovascular Surgery |volume =129 | issue =2 | pages =261–267 | date =Feb 2005 | pmid =15678034 }}</ref>
**[[Wedge resection (lung)|Wedge resection]] (removal of part of a [[Lobe (anatomy)|lobe]])
***[[Wedge resection (lung)|Wedge resection]] is performed in [[Patient|patients]] who do not have adequate [[respiratory]] reserve.
***[[Iodine-131|Radioactive iodine]] [[brachytherapy]] at the margins of [[Wedge resection (lung)|wedge resection]] may reduce the recurrence rate to that of [[lobectomy]].
**[[Lobectomy (lung)|Lobectomy]] (removal of a single [[Lobe (anatomy)|lobe]] of the [[lung]])
***[[Lobectomy]] is the preferred option for [[Patient|patients]] with adequate [[respiratory]] reserve because it reduces the chances of local recurrence.
**Bi-[[lobectomy]] (removal of two [[Lobe (anatomy)|lobes]])
**[[Pneumonectomy]] (removal of an entire [[lung]])
**[[Sleeve resection]]


=== Patient Selection ===
=== Patient Selection ===
 
*The overall operative [[mortality rate]] even after careful [[patient]] selection is about 4.4%.<ref name="Strand">{{cite journal | last =Strand | first =TE | coauthors =Rostad H, Damhuis RA, Norstein J  | title =Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude | journal =Thorax | publisher =BMJ Publishing Group Ltd. | date =Jun 2007 | pmid =17573442 }}</ref>
Not all patients are suitable for operation. The [[cancer staging|stage]], location and cell type are important limiting factors. In addition, patients who are very ill with a poor [[performance status]] or who have inadequate pulmonary reserve would be unlikely to survive. Even with careful selection, the overall operative death rate is about 4.4%.<ref name="Strand">{{cite journal | last =Strand | first =TE | coauthors =Rostad H, Damhuis RA, Norstein J  | title =Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude | journal =Thorax | publisher =BMJ Publishing Group Ltd. | date =Jun 2007 | pmid =17573442 }}</ref>
*The [[patient]] selection for lung cancer depends on:
 
**The [[cancer staging|stage]]
**Location and [[Cell (biology)|cell]] type
**[[Lung|Pulmonary]] reserve
**[[Heart|Cardiac]] evaluation
==== Stage ====
==== Stage ====
*In non-small cell lung cancer, the following [[Cancer staging|stages]] are suitable for [[surgical resection]]:<ref name="Mountain">{{cite journal | last =Mountain | first =CF | authorlink = | coauthors = | title =Revisions in the international system for staging lung cancer | journal =Chest | volume =111 | issue = | pages =1710-1717  | publisher =American College of Chest Physicians  | date =1997 | url =http://www.chestjournal.org/cgi/reprint/111/6/1710 | doi = | id = | accessdate =  }}</ref>
**Stage IA
**Stage IB
**Stage IIA
**Stage IIB
*[[Surgery|Surgical intervention]] is not recommended for the management of lung cancer [[Patient|patients]] with the following [[Cancer staging|stages]]:
**Stage IIIA
**Stage IIIB
**Stage IV


"[[Cancer staging|Stage]]" refers to the degree of spread of the cancer.
For more information on staging, please visit ''[[non-small cell lung cancer staging]].''


''See [[non-small cell lung cancer staging]]''
=== Pulmonary Reserve ===
 
*A sufficient preoperative [[Lung|pulmonary]] reserve must be present to allow adequate [[lung]] function after the [[tissue]] is removed.
In non-small cell lung cancer, stages IA, IB, IIA, and IIB are suitable for surgical resection.<ref name="Mountain">{{cite journal | last =Mountain | first =CF | authorlink = | coauthors = | title =Revisions in the international system for staging lung cancer | journal =Chest | volume =111 | issue = | pages =1710-1717  | publisher =American College of Chest Physicians  | date =1997 | url =http://www.chestjournal.org/cgi/reprint/111/6/1710 | doi = | id = | accessdate = }}</ref> Stages IIIA, IIIB, and IV tend to involve the spreading out of the cancer.  In that case [[chemotherapy]] or radiation is usually deemed the appropriate action to take because surgery will not adequately solve the diseased lungs.
*[[Lung|Pulmonary]] reserve is measured by [[spirometry]].
 
*The preoperative [[Physiological|physiologic]] evaluation established by the [[American College of Chest Physicians]] for [[Patient|patients]] with lung cancer for [[surgical resection]] include:<ref name="pmid23649437">{{cite journal| author=Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ| title=Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e166S-90S | pmid=23649437 | doi=10.1378/chest.12-2395 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649437 }} </ref><ref name="Schirren">{{cite journal | last =Schirren | first =J | authorlink = | coauthors =Krysa S, Trainer S et al.  | title =Surgical treatment and results. Carcinoma of the lung | journal =The European Respiratory Monograph | volume =1 | issue =1 | pages =212-240 | publisher = | date =1995 | url = | doi = | id = | accessdate = }}</ref>
=== Types of Surgery ===
**[[Spirometry]]
 
** Measurement of [[FEV1]] and [[DLCO|carbon monoxide diffusion capacity (DLCO)]].
* [[Lobectomy (lung)|Lobectomy]] (removal of a lobe of the lung)
***The minimum [[forced vital capacity|forced vital capacity (FVC)]] for [[pneumonectomy]] in men is 2 [[liter]]s.
* [[Pneumonectomy]] (removal of an entire lung)
***The minimum [[forced vital capacity|forced vital capacity (FVC)]] for [[lobectomy]] is 1.5 liters.
* [[Wedge resection (lung)|Wedge resection]]
*** In [[Female|women]], the minimum [[FVC]] values for [[pneumonectomy]] and [[lobectomy]] are 1.75 liters and 1.25 liters, respectively.
* [[Sleeve resection]]
*[[Surgery]] is contraindicated if [[spirometry]] reveals poor [[respiratory]] reserve which is often due to underlying [[chronic obstructive pulmonary disease|chronic obstructive pulmonary disease (COPD)]].


==References==
==References==

Latest revision as of 20:47, 8 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Lung cancer surgery involves the surgical excision of the cancerous tissue. It is used mainly in non-small cell lung cancer with the intention of curing the patient.

Surgery

Patient Selection

Stage

For more information on staging, please visit non-small cell lung cancer staging.

Pulmonary Reserve

References

  1. ↑ El-Sherif, A (Aug 2006). "Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis". Annals of Thoracic Surgery. 82 (2): 408–415. PMID 16863738. Unknown parameter |coauthors= ignored (help)
  2. ↑ Fernando, HC (Feb 2005). "Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer". Journal of Thoracic and Cardiovascular Surgery. 129 (2): 261–267. PMID 15678034. Unknown parameter |coauthors= ignored (help)
  3. ↑ Strand, TE (Jun 2007). "Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude". Thorax. BMJ Publishing Group Ltd. PMID 17573442. Unknown parameter |coauthors= ignored (help)
  4. ↑ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest. American College of Chest Physicians. 111: 1710–1717.
  5. ↑ Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ (2013). "Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e166S–90S. doi:10.1378/chest.12-2395. PMID 23649437.
  6. ↑ Schirren, J (1995). "Surgical treatment and results. Carcinoma of the lung". The European Respiratory Monograph. 1 (1): 212–240. Unknown parameter |coauthors= ignored (help)

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