Surgical Aspects in Lung Cancer Management

1
Surgical Aspects in Lung Cancer Management

• Mike Poullis
• CTC Liverpool

2
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

3
Overview

• Diagnostic
• Bronchoscopy
• VATS
• Mediasteinoscopy
• Mediasteinotomy
• Treatment
• Wedge
• Lobectomy
• Combined wedge and lobectomy
• Pneumonectomy
• Palliation
• Effusions

4
Diagnostic Bronchoscopy
5
Diagnostic Bronchoscopy

• Rigid and flexible scope
• Biopsy and selective washings
• Larger samples than flexible scope
• Exact location
• Lobectomy
• Pneumonectomy
• Unresectable
• Sleeve

6
Diagnostic Bronchoscopy
7
Diagnostic VATS (Video Assisted Thoracic
Surgery)

• Diagnosis of pleural disease

8
Diagnostic VATS
9
Mediasteinoscopy Mediasteinotomy

• Different
• lymph node
• stations

10
Mediasteinoscopy Mediasteinotomy
11
Mediasteinoscopy Mediasteinotomy

• Different surgical cuts

12
Diagnostic Mediasteinoscopy Mediasteinotomy

• Diagnoses unresectable disease
• Eliminate N2 disease from surgical resection

13
Surgical Assessment

• How fit is the patient ?
• What is the
• stage,
• histology,
• exact size and
• location ?

14
How Fit Is the Patient ?

• Performance status
• Pulmonary function tests
• Age
• Medical and surgical conditions
• What operation do they need

15
Stage

• Assuming fit patient
• Can and should you take it out
• N2 or N3 disease
• T4 disease

16
Histology

• Eliminate benign disease
• Beware false negative biopsy
• Beware scar cancers
• Eliminate small cell patients

17
Exact size and location ?
All T1N0 non small cell carcinoma
18
Treatment

• Wedge
• Lobectomy
• Combined wedge and lobectomy
• Pneumonectomy

19
Thoracotomy

• Posterolateral
• Anterolateral
• Lateral
• Mini
• Muscle sparing

20
Incision
21
Treatment Wedge
22
Treatment Wedge

• Small nodules in poor pulmonary function patients

23
Treatment Lobectomy

• Gold standard
• Left LUL, LLL,
• Right RUL/-RML, RLL/-RML, RML
• Never RUL and RLL

24
Treatment Lobectomy
25
Treatment Pneumonectomy

• Extensive tumours only
• Intrapericardial or extrapericardial

26
Outcomes After Surgery
27
Chemotherapy and Radiotherapy

• Adjuvant
• Neoadjuvant
• Down staging
• Unexpected N2, or positive margins
• All small cell

28
Small Cell

• Small nodule needle biopsy shows small cell
• If bone scan, and CT head negative refer
• If mediasteinoscopy negative then ? Surgical
  resection

29
Palliation

• Pleural effusions
• Drainage, and pleurodesis
• Pleurectomy
• Talc
• Noxious chemotherapeutic agent
• Decortication
• Removal of tumour mass surrounding lung in
  pleural space
• BENIGN DISEASE DIFFERENT

30
Any Questions ?