Pancoast tumor surgery: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 5: Line 5:
[[Surgery]] is the mainstay of [[therapy]] for early-stage Pancoast tumor. [[Surgical procedure]] selection will depend on the [[histology]], margins, and [[Tumor|size of the tumor]]. Common [[surgical procedures]] for the [[Treatments|treatment]] of Pancoast tumor, include [[lung]] [[resection]] with [[lobectomy]], [[lung]] [[resection]] with [[pneumonectomy]] with or without [[Lymph nodes|lymph node]] [[dissection]], [[thoracotomy]] with the removal of the entire [[lung]] or [[lobe]] ([[lobectomy]]) along with regional [[lymph nodes]] ([[Peribronchial cuffing|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]]. [[Surgery|Surgical]] [[Cancer staging|staging]] of the [[mediastinum]] is considered standard if accurate evaluation of the [[Lymph node metastases|nodal status]] is needed to determine [[therapy]]. [[Surgery|Surgical]] [[Treatments|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 [[Excision|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 lung carcinoma|large-cell carcinoma]] and the [[adenocarcinoma]]. If the [[tumor]] is inoperable, [[Stereotactic radiosurgery|stereotactic ablative radiation therapy]] should be administered.
[[Surgery]] is the mainstay of [[therapy]] for early-stage Pancoast tumor. [[Surgical procedure]] selection will depend on the [[histology]], margins, and [[Tumor|size of the tumor]]. Common [[surgical procedures]] for the [[Treatments|treatment]] of Pancoast tumor, include [[lung]] [[resection]] with [[lobectomy]], [[lung]] [[resection]] with [[pneumonectomy]] with or without [[Lymph nodes|lymph node]] [[dissection]], [[thoracotomy]] with the removal of the entire [[lung]] or [[lobe]] ([[lobectomy]]) along with regional [[lymph nodes]] ([[Peribronchial cuffing|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]]. [[Surgery|Surgical]] [[Cancer staging|staging]] of the [[mediastinum]] is considered standard if accurate evaluation of the [[Lymph node metastases|nodal status]] is needed to determine [[therapy]]. [[Surgery|Surgical]] [[Treatments|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 [[Excision|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 lung carcinoma|large-cell carcinoma]] and the [[adenocarcinoma]]. If the [[tumor]] is inoperable, [[Stereotactic radiosurgery|stereotactic ablative radiation therapy]] should be administered.
==Surgery==
==Surgery==
In [[non-small cell lung cancer]], [[surgical procedure]] selection will depend on the [[histology]], margins, and [[Tumor|size of the tumor]].<ref name="pmid22054885">{{cite journal |vauthors=von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT |title=Functional evaluation before lung resection |journal=Clin. Chest Med. |volume=32 |issue=4 |pages=773–82 |year=2011 |pmid=22054885 |doi=10.1016/j.ccm.2011.08.001 |url=}}</ref><ref name="pmid16618956">{{cite journal |vauthors=Smetana GW, Lawrence VA, Cornell JE |title=Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians |journal=Ann. Intern. Med. |volume=144 |issue=8 |pages=581–95 |year=2006 |pmid=16618956 |doi= |url=}}</ref><ref name="surgery">Surgery of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/treatment/surgery/?region=ab</ref>
In [[non-small cell lung cancer]], [[surgical procedure]] selection will depend on the [[histology]], margins, and [[Tumor|size of the tumor]].<ref name="pmid22054885">{{cite journal |vauthors=von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT |title=Functional evaluation before lung resection |journal=Clin. Chest Med. |volume=32 |issue=4 |pages=773–82 |year=2011 |pmid=22054885 |doi=10.1016/j.ccm.2011.08.001 |url=}}</ref><ref name="pmid16618956">{{cite journal |vauthors=Smetana GW, Lawrence VA, Cornell JE |title=Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians |journal=Ann. Intern. Med. |volume=144 |issue=8 |pages=581–95 |year=2006 |pmid=16618956 |doi= |url=}}</ref><ref name="surgery">Surgery of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/treatment/surgery/?region=ab</ref><ref name="pmid19010280">{{cite journal |vauthors=Davis GA, Knight SR |title=Pancoast tumors |journal=Neurosurg. Clin. N. Am. |volume=19 |issue=4 |pages=545–57, v–vi |date=October 2008 |pmid=19010280 |doi=10.1016/j.nec.2008.07.002 |url=}}</ref><ref name="pmid27079507">{{cite journal |vauthors=Rosso L, Palleschi A, Mendogni P, Nosotti M |title=Video-assisted pulmonary lobectomy combined with transmanubrial approach for anterior Pancoast tumor resection: case report |journal=J Cardiothorac Surg |volume=11 |issue=1 |pages=65 |date=April 2016 |pmid=27079507 |pmc=4831106 |doi=10.1186/s13019-016-0446-7 |url=}}</ref><ref name="pmid25052071">{{cite journal |vauthors=Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI |title=A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches |journal=Interact Cardiovasc Thorac Surg |volume=19 |issue=3 |pages=426–35 |date=September 2014 |pmid=25052071 |doi=10.1093/icvts/ivu115 |url=}}</ref><ref name="pmid21471804">{{cite journal |vauthors=Hubbard MO, Schroeder C, Linden PA |title=Routine use of staging thoracoscopy for pancoast tumors without overt radiographic chest wall invasion |journal=Surg Laparosc Endosc Percutan Tech |volume=21 |issue=2 |pages=111–5 |date=April 2011 |pmid=21471804 |doi=10.1097/SLE.0b013e31821a3cb0 |url=}}</ref><ref name="pmid19699106">{{cite journal |vauthors=Tamura M, Hoda MA, Klepetko W |title=Current treatment paradigms of superior sulcus tumours |journal=Eur J Cardiothorac Surg |volume=36 |issue=4 |pages=747–53 |date=October 2009 |pmid=19699106 |doi=10.1016/j.ejcts.2009.04.036 |url=}}</ref>


*[[Surgery]] is the mainstay of [[therapy]] for early-stage Pancoast tumor .  
*[[Surgery]] is the mainstay of [[therapy]] for early-stage Pancoast tumor .  

Revision as of 21:54, 4 March 2018


Pancoast tumor Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pancoast tumor 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

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

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

Pancoast tumor surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pancoast tumor surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pancoast tumor surgery

CDC onPancoast tumor surgery

Pancoast tumor surgery in the news

Blogs on Pancoast tumor surgery

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Pancoast tumor surgery

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. Common surgical procedures for the treatment of Pancoast tumor, include lung resection with lobectomy, lung resection with pneumonectomy with or without lymph node dissection, 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.

Surgery

In non-small cell lung cancer, surgical procedure selection will depend on the histology, margins, and size of the tumor.[1][2][3][4][5][6][7][8]

Evaluation before surgery

  • Resectable
  • Unresectable
  • Because surgery to treat Pancoast tumor is a major operation, the person needs to be in good overall health and be able to tolerate surgery. Lung and heart function tests are done to make sure that people are healthy enough to have surgery and that they will have enough lung function after surgery.
  • The type of surgery done depends on the size and location of a 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

  • A wedge or segmental resection may be offered for very early stage Pancoast tumor to preserve as much lung function as possible. These procedures may also be done in people with more advanced lung cancer who may have poor lung function after surgery.

Lobectomy

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

Pneumonectomy

Extended pulmonary resection

Sleeve resection

Lymph node removal

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.

Thoracentesis

Pleurodesis

Surgery for metastatic Pancoast tumor

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.

Indications

Surgery is usually reserved for patients with the following characteristics:[1]

  • Preoperative assessment of FEV1/DLCO
  • FEV1 >2 L (or more than 80%)
  • DLCO > 80
  • Successful cutoff of 22 m on the stair climbing test

Contraindications

Surgery is usually contraindicated in patients with the following characteristics:[2]

  • Involvement of contralateral hemithorax
  • Invasion of structures of the mediastinum

Complications

Common complications of Pancoast tumor surgery, include:[2]

References

  1. 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. 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.
  3. Surgery of non–small cell lung cancer. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/lung/treatment/surgery/?region=ab
  4. Davis GA, Knight SR (October 2008). "Pancoast tumors". Neurosurg. Clin. N. Am. 19 (4): 545–57, v–vi. doi:10.1016/j.nec.2008.07.002. PMID 19010280.
  5. Rosso L, Palleschi A, Mendogni P, Nosotti M (April 2016). "Video-assisted pulmonary lobectomy combined with transmanubrial approach for anterior Pancoast tumor resection: case report". J Cardiothorac Surg. 11 (1): 65. doi:10.1186/s13019-016-0446-7. PMC 4831106. PMID 27079507.
  6. Caronia FP, Fiorelli A, Ruffini E, Nicolosi M, Santini M, Lo Monte AI (September 2014). "A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches". Interact Cardiovasc Thorac Surg. 19 (3): 426–35. doi:10.1093/icvts/ivu115. PMID 25052071.
  7. Hubbard MO, Schroeder C, Linden PA (April 2011). "Routine use of staging thoracoscopy for pancoast tumors without overt radiographic chest wall invasion". Surg Laparosc Endosc Percutan Tech. 21 (2): 111–5. doi:10.1097/SLE.0b013e31821a3cb0. PMID 21471804.
  8. Tamura M, Hoda MA, Klepetko W (October 2009). "Current treatment paradigms of superior sulcus tumours". Eur J Cardiothorac Surg. 36 (4): 747–53. doi:10.1016/j.ejcts.2009.04.036. PMID 19699106.

Template:WH Template:WS