Lung cancer surgery: Difference between revisions
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=== Pulmonary reserve === | === Pulmonary reserve === | ||
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> | The [[American College of Chest Physicians]] established [[clinical practice guideline]]s in 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== | ||
Revision as of 16:29, 19 February 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]
Overview
Lung cancer surgery describes the use of surgical operations in the treatment of lung cancer. 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.
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 tests 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.[1] 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 guidelines in for the physiologic evaluation of patients with lung cancer being considered for resectional surgery.[2] 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 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.[3]
Surgery
Procedures include wedge resection (removal of part of a lobe), 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.[4] Radioactive iodine brachytherapy at the margins of wedge excision may reduce recurrence to that of lobectomy.[5]
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.
Patient selection
Not all patients are suitable for operation. The 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%.[1]
Stage
"Stage" refers to the degree of spread of the cancer.
See non-small cell lung cancer staging
In non-small cell lung cancer, stages IA, IB, IIA, and IIB are suitable for surgical resection.[6] 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.
Types of surgery
- Lobectomy (removal of a lobe of the lung)
- Pneumonectomy (removal of an entire lung)
- Wedge resection
- Sleeve resection
References
- ↑ 1.0 1.1 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) - ↑ 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) - ↑ 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) - ↑ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest. American College of Chest Physicians. 111: 1710–1717.