Lung cancer surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Lung cancer surgery involves the surgical excision of | Lung cancer [[surgery]] involves the [[Excision|surgical excision]] of the [[Cancer|cancerous]] [[Tissue (biology)|tissue]]. It is used mainly in [[non-small cell lung cancer]] with the intention of [[Cure|curing]] the [[patient]]. | ||
==Surgery== | ==Surgery== | ||
*Surgery is the best treatment option | *[[Surgery]] is the best treatment option for [[Patient|patients]] with [[Resection|resectable]] [[Tumor|tumors]]. | ||
*The feasibility of surgery depends on the stage of lung cancer at the time of diagnosis. | *The feasibility of [[surgery]] depends on the [[Cancer staging|stage]] of lung cancer at the time of [[diagnosis]]. | ||
*The procedures for lung cancer | *The [[Surgery|surgical]] [[Procedure|procedures]] for lung cancer include:<ref name="El-Sherif">{{cite journal | last =El-Sherif | first =A | coauthors =Gooding WE, Santos R et al. | title =Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis | journal =Annals of Thoracic Surgery | volume =82 | issue =2 | pages =408–415 | date =Aug 2006 | pmid =16863738 }}</ref><ref name="Fernando">{{cite journal | last =Fernando | first =HC | coauthors =Santos RS, Benfield JR et al. | title =Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer | journal =Journal of Thoracic and Cardiovascular Surgery |volume =129 | issue =2 | pages =261–267 | date =Feb 2005 | pmid =15678034 }}</ref> | ||
**[[Wedge resection (lung)|Wedge resection]] (removal of part of a lobe) | **[[Wedge resection (lung)|Wedge resection]] (removal of part of a [[Lobe (anatomy)|lobe]]) | ||
***Wedge resection is performed in | ***[[Wedge resection (lung)|Wedge resection]] is performed in [[Patient|patients]] who do not have adequate [[respiratory]] reserve. | ||
***Radioactive iodine brachytherapy at the margins of wedge resection may reduce recurrence to that of lobectomy. | ***[[Iodine-131|Radioactive iodine]] [[brachytherapy]] at the margins of [[Wedge resection (lung)|wedge resection]] may reduce the recurrence rate to that of [[lobectomy]]. | ||
**[[Lobectomy (lung)|Lobectomy]] (removal of a single lobe of the lung) | **[[Lobectomy (lung)|Lobectomy]] (removal of a single [[Lobe (anatomy)|lobe]] of the [[lung]]) | ||
***Lobectomy is the preferred option for patients with adequate respiratory reserve because it reduces the chances of local recurrence. | ***[[Lobectomy]] is the preferred option for [[Patient|patients]] with adequate [[respiratory]] reserve because it reduces the chances of local recurrence. | ||
** | **Bi-[[lobectomy]] (removal of two [[Lobe (anatomy)|lobes]]) | ||
**[[Pneumonectomy]] (removal of an entire lung) | **[[Pneumonectomy]] (removal of an entire [[lung]]) | ||
**[[Sleeve resection]] | **[[Sleeve resection]] | ||
=== Patient Selection === | === Patient Selection === | ||
*The overall operative mortality rate even after careful patient selection is about 4.4%.<ref name="Strand">{{cite journal | last =Strand | first =TE | coauthors =Rostad H, Damhuis RA, Norstein J | title =Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude | journal =Thorax | publisher =BMJ Publishing Group Ltd. | date =Jun 2007 | pmid =17573442 }}</ref> | *The overall operative [[mortality rate]] even after careful [[patient]] selection is about 4.4%.<ref name="Strand">{{cite journal | last =Strand | first =TE | coauthors =Rostad H, Damhuis RA, Norstein J | title =Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude | journal =Thorax | publisher =BMJ Publishing Group Ltd. | date =Jun 2007 | pmid =17573442 }}</ref> | ||
*The patient selection for lung cancer depends on: | *The [[patient]] selection for lung cancer depends on: | ||
**The [[cancer staging|stage]] | **The [[cancer staging|stage]] | ||
**Location and cell type | **Location and [[Cell (biology)|cell]] type | ||
**Pulmonary reserve | **[[Lung|Pulmonary]] reserve | ||
**Cardiac evaluation | **[[Heart|Cardiac]] evaluation | ||
==== Stage ==== | ==== Stage ==== | ||
*In non-small cell lung cancer the following stages are suitable for surgical resection:<ref name="Mountain">{{cite journal | last =Mountain | first =CF | authorlink = | coauthors = | title =Revisions in the international system for staging lung cancer | journal =Chest | volume =111 | issue = | pages =1710-1717 | publisher =American College of Chest Physicians | date =1997 | url =http://www.chestjournal.org/cgi/reprint/111/6/1710 | doi = | id = | accessdate = }}</ref> | *In non-small cell lung cancer, the following [[Cancer staging|stages]] are suitable for [[surgical resection]]:<ref name="Mountain">{{cite journal | last =Mountain | first =CF | authorlink = | coauthors = | title =Revisions in the international system for staging lung cancer | journal =Chest | volume =111 | issue = | pages =1710-1717 | publisher =American College of Chest Physicians | date =1997 | url =http://www.chestjournal.org/cgi/reprint/111/6/1710 | doi = | id = | accessdate = }}</ref> | ||
**Stage IA | **Stage IA | ||
**Stage IB | **Stage IB | ||
**Stage IIA | **Stage IIA | ||
**Stage IIB | **Stage IIB | ||
*Surgical intervention is not recommended for the management of lung cancer patients with the following stages: | *[[Surgery|Surgical intervention]] is not recommended for the management of lung cancer [[Patient|patients]] with the following [[Cancer staging|stages]]: | ||
**Stage IIIA | **Stage IIIA | ||
**Stage IIIB | **Stage IIIB | ||
**Stage IV | **Stage IV | ||
'' | For more information on staging, please visit ''[[non-small cell lung cancer staging]].'' | ||
=== Pulmonary Reserve === | === Pulmonary Reserve === | ||
*A sufficient | *A sufficient preoperative [[Lung|pulmonary]] reserve must be present to allow adequate [[lung]] function after the [[tissue]] is removed. | ||
*Pulmonary reserve is measured by [[spirometry]]. | *[[Lung|Pulmonary]] reserve is measured by [[spirometry]]. | ||
*The preoperative physiologic evaluation established by the [[American College of Chest Physicians]] for patients with lung cancer for | *The preoperative [[Physiological|physiologic]] evaluation established by the [[American College of Chest Physicians]] for [[Patient|patients]] with lung cancer for [[surgical resection]] include:<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><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> | ||
**[[Spirometry]] | **[[Spirometry]] | ||
** Measurement of FEV1 and carbon monoxide diffusion capacity (DLCO). | ** Measurement of [[FEV1]] and [[DLCO|carbon monoxide diffusion capacity (DLCO)]]. | ||
***The minimum [[forced vital capacity | ***The minimum [[forced vital capacity|forced vital capacity (FVC)]] for [[pneumonectomy]] in men is 2 [[liter]]s. | ||
***The minimum [[forced vital capacity | ***The minimum [[forced vital capacity|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. | *** In [[Female|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]] | *[[Surgery]] is contraindicated if [[spirometry]] reveals poor [[respiratory]] reserve which is often due to underlying [[chronic obstructive pulmonary disease|chronic obstructive pulmonary disease (COPD)]]. | ||
==References== | ==References== | ||
Latest revision as of 20:47, 8 July 2019
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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 the cancerous tissue. It is used mainly in non-small cell lung cancer with the intention of curing the patient.
Surgery
- Surgery is the best treatment option for patients with resectable tumors.
- The feasibility of surgery depends on the stage of lung cancer at the time of diagnosis.
- The surgical procedures for lung cancer include:[1][2]
- Wedge resection (removal of part of a lobe)
- Wedge resection is performed in patients who do not have adequate respiratory reserve.
- Radioactive iodine brachytherapy at the margins of wedge resection may reduce the recurrence rate 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.
- Bi-lobectomy (removal of two lobes)
- Pneumonectomy (removal of an entire lung)
- Sleeve resection
- Wedge resection (removal of part of a lobe)
Patient Selection
- The overall operative mortality rate even after careful patient selection is about 4.4%.[3]
- The patient selection for lung cancer depends on:
Stage
- In non-small cell lung cancer, the following stages are suitable for surgical resection:[4]
- 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
For more information on staging, please visit non-small cell lung cancer staging.
Pulmonary Reserve
- A sufficient preoperative 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 surgical resection include:[5][6]
- 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 (COPD).
References
- ↑ 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) - ↑ 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) - ↑ Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest. American College of Chest Physicians. 111: 1710–1717.
- ↑ 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)