Lung cancer surgery

Lung cancer Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Lung cancer from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Lung cancer surgery On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Lung cancer surgery All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Lung cancer surgery
CDC on Lung cancer surgery
Lung cancer surgery in the news
Blogs on Lung cancer surgery
Directions to Hospitals Treating Lung cancer
Risk calculators and risk factors for Lung cancer surgery

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:
  • 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

Patient Selection

• The overall operative mortality rate even after careful patient selection is about 4.4%.
• 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:
  • 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:
  • 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 forced vital capacity (FVC) 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

Template:WikiDoc Sources