Lung cancer surgery
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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 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.
Surgery
- Surgery is the best treatment option of lung cancer for patients with resectable tumors.
- The feasibility of surgery depends on the stage of lung cancer at the time of diagnosis.
- The procedures for lung cancer imclude:[1][2]
- Wedge resection (removal of part of a lobe)
- Wedge resection is performed in the patients who do not have adequate respiratory reserve.
- Radioactive iodine brachytherapy at the margins of wedge resection may reduce recurrence to that of lobectomy.
- Lobectomy (removal of a single lobe of the lung)
- Lobectomy is the preferred option for patients with adequate respiratory reserve because it reduces the chances of local recurrence.
- Bilobectomy (two lobes)
- Pneumonectomy (removal of an entire lung)
- Sleeve resection
- Wedge resection (removal of part of a lobe)
Patient Selection
- The overall operative mortality rate even after careful patient selection is about 4.4%.[3]
- The patient selection for lung cancer depends on:
- The stage
- Location and cell type.
- Pulmonary reserve
- Cardiac evaluation
Stage
- In non-small cell lung cancer the following stages are suitable for surgical resection:[4]
- Stage IA
- Stage IB
- Stage IIA
- Stage IIB
- Surgical intervention is not recommended for the management of lung cancer patients with the following stages:
- Stage IIIA
- Stage IIIB
- Stage IV
See non-small cell lung cancer staging
Pulmonary Reserve
- A sufficient pre-operative pulmonary reserve must be present to allow adequate lung function after the tissue is removed.
- Pulmonary reserve is measured by spirometry.
- The preoperative physiologic evaluation established by the American College of Chest Physicians for patients with lung cancer for resectional surgery include:[5][6]
- Spirometry
- Measurement of FEV1 and carbon monoxide diffusion capacity (DLCO).
- The minimum forced vital capacity (FVC) for pneumonectomy in men is 2 liters.
- 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.
- Surgery is contraindicated if spirometry reveals poor respiratory reserve which is often due to underlying chronic obstructive pulmonary disease).
References
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest. American College of Chest Physicians. 111: 1710–1717.
- ↑ 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.
- ↑ Schirren, J (1995). "Surgical treatment and results. Carcinoma of the lung". The European Respiratory Monograph. 1 (1): 212–240. Unknown parameter
|coauthors=ignored (help)