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.[1]

Surgery

Evaluation before surgery[1]

  • 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

  • Extended pulmonary resection is used to treat tumours that have spread to the chest wall, diaphragm, nerves, blood vessels or other tissues near the lung. During surgery, a complete section (en bloc) of the surrounding tissue is removed to try to take out as much of the cancer as possible.

Sleeve resection

  • A sleeve resection is used to treat tumours in the large bronchus of the lung. The tumour is removed from the bronchus, along with a margin of healthy tissue on either side of the tumour. The 2 ends of the bronchus are then joined together (anastomosis).

Lymph node removal

  • Lymph nodes play a large part in the staging and prognosis of non–small cell lung cancer, as well as in planning for surgery. During diagnosis, tests may show if the cancer has spread to certain lymph nodes.
  • 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

  • Non–small cell lung cancer can grow into the bronchus, causing breathing problems or pneumonia. A stent is a small metal or plastic tube that is placed into the bronchus during a bronchoscopy. It keeps the airway open and allows air into the lungs.

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.
  • Thoracentesis may be used with non–small cell lung cancer to treat:
  • Air leaking from the lung into the chest, causing the lung to collapse (pneumothorax)
  • Bleeding into the chest (hemothorax)
  • A buildup of fluid in the pleural cavity (pleural effusion)

Pleurodesis

  • Pleurodesis is done to prevent a buildup of fluid in the pleural cavity and pleural effusion. Excess pleural fluid is drained, and then drugs or chemicals, such as sterile talc, are put into the pleural space through a chest tube. Pleurodesis seals the parietal pleura and visceral pleura together so there is no longer a space between them in which fluid could build up.

Surgery for metastatic non–small cell lung cancer

  • Surgery may be done to remove a single metastatic tumour that has spread from the lung to the:
  • Brain
  • Adrenal gland

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.
  • VATS may be used to remove small (3–4 cm) non–small cell lung cancer tumours from the outer edges (periphery) of the lung. A lobectomy may also be done using VATS.

References

  1. 1.0 1.1 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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