Adenocarcinoma of the lung surgery

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

Overview

Surgery is the mainstay of treatment for adenocarcinoma of the lung.

Surgery

Evaluation before surgery

  • Resectable:
  • Unresectable:
  • Lung surgery is done through an incision between the ribs on the side of the chest (thoracotomy). The ribs are spread so the surgeon can reach the lung.
  • The type of surgery done depends on the size and location of the tumour and how far it has spread within the lung. Side effects of surgery depend on the type of surgical procedure.

Wedge or segmental resection

Lobectomy

  • A lobectomy is the removal of the lobe of the lung that has the tumor.
  • A bilobectomy is the removal of 2 lobes of the right lung, which has 3 lobes. This surgery may be done if the tumor has spread into 2 joining lobes. The upper and middle lobes or the middle and lower lobes may be removed during a bilobectomy.

Pneumonectomy

  • A pneumonectomy is the removal of a whole lung during surgery. This surgery is done if the tumor has spread either:
  • Across both lobes of the left lung
  • To the hilum of the lung
  • There are more complications with pneumonectomy when the right lung (the larger lung) is removed.

Extended pulmonary resection

Sleeve resection

Lymph node removal

  • N1 nodes – Cancer that has spread to these nodes can usually be completely removed with surgery.
  • N2 nodes – It may not be possible to completely remove cancer that has spread to these nodes, so surgery may not be an option.
  • N3 nodes – Cancer that has spread to these nodes cannot be completely removed with surgery, so surgery is not an option.

Stent placement

Chest tube placement

  • During surgery, a flexible tube will be inserted through a cut in the skin, between the ribs and into the space between the lungs and the wall of the chest (pleural cavity). The tube is connected to a bottle with sterile water and a suction machine. It may be held in place with stitches or tape.
  • A chest tube is used to drain blood, other fluids and air from the space around the lungs (pleural space) after surgery. It is left in place until x-rays show that the blood, fluids or air have been drained and that the lung can fully expand.

Thoracentesis

  • A thoracentesis is a procedure in which a hollow needle is inserted through the skin and between the ribs into the space between the lungs and the wall of the chest (pleural cavity). It is used to drain fluid or air from the chest cavity.

Pleurodesis

Surgery for metastatic non–small cell lung cancer

Video-assisted thoracic surgery (VATS)

  • Video-assisted thoracic surgery (VATS) is a less invasive type of surgery. It uses a small video camera and surgical tools inserted through several small incisions in the chest wall. The surgeon is guided by an image on a video screen.

References

  1. Surgery of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/treatment/surgery/?region=ab

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