Pulmonary nodule surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Surgical excision is the mainstay therapy for malignant or high risk pulmonary nodules. In pulmonary nodule, surgical procedure selection will depend on the size, margins, and size of the tumor. The preferred surgical procedure is wedge resection by video-assisted thoracic surgery and pathological evaluation.

Surgery

• Surgical excision is the mainstay therapy for malignant or high risk pulmonary nodules
• Surgical excision is also the primary choice for the definitive diagnosis of malignant pulmonary nodules
• In pulmonary nodule, surgical procedure selection will depend on the size, margins, and size of the tumor.
• Common surgical procedures for the treatment of pulmonary nodule, include:

• Wedge resection
• Lobectomy
• Segmentectomy
• Lung volume reduction surgery
• The preferred surgical procedure is wedge resection by video-assisted thoracic surgery and pathological evaluation.

• The majority of surgical excisions include preoperative localization techniques, such as: preoperative placement of dye, technetium-99 radioguidance, ultrasound, or fluoroscopy.
• In some cases, surgical excision may be preferred by patients with the following characteristics:

• Non-compliant with follow-up
• Desire for diagnostic certainty
• Willingness to accept the risks associated with surgery

Complications

Common complications of solitary pulmonary nodule, include:

• Atelectasis
• Infection

• Nosocomial pneumonia

• Prolonged mechanical ventilation
• Respiratory failure
• Bronchospasm
• Pulmonary embolism