Lung cancer surgery

Lung cancer surgery describes the use of surgical operations in the treatment of lung cancer. 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.

Patient selection

Not all patients are suitable for operation. The stage, location and cell type are important limiting factors. In addition, patients who are very ill with a poor performance status or who have inadequate pulmonary reserve would be unlikely to survive. Even with careful selection, the overall operative death rate is about 4.4%.^[1]

Stage

In non-small cell lung cancer, stages IA, IB, IIA, and IIB are suitable for surgical resection.^[2]

Pulmonary reserve

Pulmonary reserve is measured by spirometry. If there is no evidence of undue shortness of breath or diffuse parenchymal lung disease, and the FEV₁ exceeds 2 litres or 80% of predicted, the patient is fit for pneumonectomy. If the FEV₁ exceeds 1.5 litres, the patient is fit for lobectomy.^[3]

Types of surgery

• Lobectomy (removal of a lobe of the lung)^[4] See a video of a Lobectomy
• Sublobar resection (removal of part of love of the lung)
• Segmentectomy (removal of an anatomic division of a particular lobe of the lung)
• Pneumonectomy (removal of an entire lung)
• Wedge resection
• Sleeve/bronchoplastic resection (removal of an associated tubular section of the associated main bronchial passage during lobectomy with subsequent reconstruction of the bronchial passage)
• VATS lobectomy (minimally invasive approach to lobectomy that may allow for diminished pain, quicker return to full activity, and diminished hospital costs)^[5][6]

References

1. Strand, TE; Rostad H; Damhuis RA; Norstein J (Jun 2007). "Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude". Thorax. BMJ Publishing Group Ltd. 62 (11): 991–7. doi:10.1136/thx.2007.079145. PMC 2117132. PMID 17573442.
2. Mountain, CF (1997). "Revisions in the international system for staging lung cancer". Chest. American College of Chest Physicians. 111 (6): 1710–1717. doi:10.1378/chest.111.6.1710. PMID 9187198.
3. Colice, GL; Shafazand S; Griffin JP; et al. (September 2007). "Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (Suppl. 3): 161S–177S. doi:10.1378/chest.07-1359. PMID 17873167.
4. Fell, SC; TJ Kirby (2005). General Thoracic Surgery (sixth ed.). Lippincott Williams & Wilkins. pp. 433–457. ISBN 0-7817-3889-X.
5. Nicastri DG, Wisnivesky JP, Litle VR, et al. (March 2008). "Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance". J Thorac Cardiovasc Surg. 135 (3): 642–7. doi:10.1016/j.jtcvs.2007.09.014. PMID 18329487.
6. Casali G, Walker WS (March 2009). "Video-assisted thoracic surgery lobectomy: can we afford it?". Eur J Cardiothorac Surg. 35 (3): 423–8. doi:10.1016/j.ejcts.2008.11.008. PMID 19136272.