Pancoast tumor surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]
Overview
Surgery is the mainstay of therapy for early-stage Pancoast tumor. Surgical procedure selection will depend on the histology, margins, and size of the tumor.
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 Pancoast tumor .
- Common surgical procedures for the treatment of Pancoast tumor, 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 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 tumor is inoperable, stereotactic ablative radiation therapy should be administered.
Indications
Surgery is usually reserved for patients with the following characteristics:[1]
- Pulmonary function testing
- Exercise testing
- Successful cutoff of 22 m on the stair climbing test
- Fitness for surgery
- Evaluation of risk factors, such as:
- Age
- General health status (obesity, Karnofsky scale >70)
- COPD/Asthma
- Smoking
- Other conditions: pulmonary hypertension, heart failure, and metabolic factors
Contraindications
Surgery is usually contraindicated in patients with the following characteristics:[2]
- 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]
- Prolonged mechanical ventilation
- Respiratory failure
- Bronchospasm
- Pulmonary embolism
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.