Transcript Surgical Management of Lung Cancer

Thoracic Surgery
By Mike Poullis
Overview
• What is it ?
• What do you need to know as a nurse on the
ward ?
What do you need to know as a
nurse on the ward ?
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Different pathologies
Different operations
Chest drains
Post operative care
Different pathologies
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Lung cancer
Pneumothorax
Pleural effusions
Lung biopsies
• Trauma
• Oddities
Different operations
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Bronchoscopy (oesophagoscopy)
Mediasteinoscopy
Mediasteinotomy / Chamberlains
Thoracoscopy VATS
Mini thoracotomy
Full thoracotomy
• Pneumonectomy / Lobectomy / Wedge
Anatomy
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Trachea
2 bronchi
2 Lungs
3 lobes on left
2 lobes on right
The Right Lung
The Left Lung
Bronchial system
Lung cancer
• Small cell
• Non small cell
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Squamous
Adeno
Large cell
Undifferentiated
Lung cancer
• Except for small cell carcinoma of the lung
it is generally accepted that surgery is the
most effective therapy for lung carcinoma
Small Cell Lung Cancer
Assessment of Patient
• Fitness for surgery
• Operability of the tumour - Staging
Staging
• TNM
• T size and position of tumour
• N lymph node status
• M metastasis
Stage IA of Lung Cancer
Stage IB of Lung Cancer
Stage IIA of Lung Cancer
Stage IIB of Lung Cancer
Stage IIIA of Lung Cancer
Stage IIIB of Lung Cancer
Stage IV of Lung Cancer
IV:
Any T,
Any N,
M1
Synchronous
tumours in
different lobes are
M1
Fitness for Surgery
• Age
• Pulmonary function
• Cardiovascular function
• Medical conditions
• Nutritional Status
• Performance status
Assessment of Operability
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CT scan
Bone scan
PET scan
Mediastinoscopy
Anterior Mediastinotomy
VATS
Bronchoscopy
oesophagoscopy
Mediastinoscopy
Mediastinotomy / Chamberlains
Mediastinotomy
Thoracoscopy
Video Assisted Thoracic Surgery
Thoracotomy
Thoracotomy - Posterolateral
Thoracotomy - Anterolateral
Mini thoracotomy
• Small incision thoracotomy
Lung Resection
• Pneumonectomy
• Lobectomy
• Wedge
Lung Resection – Pneumonectomy
Lung Resection – Lobectomy (RUL)
Lung Resection – Lobectomy (RUL)
Wedge resection
Pleural effusions
• Fluid in chest
• Due to underlying cause
• Usually malignant, but what ?
• Drain for
– Symptoms
– Diagnosis
Pneumothorax
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What is a pneumothorax ?
How do you treat them ?
Who requires surgery ?
What does surgery entail ?
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Thoracotomy
Sternotomy
Mini thoracotomy
VATS
Lung biopsies
• Need tissue to diagnose “Interstitial lung
disease”
Open lung biopsy
Chest drains
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What are they ?
Why use them ?
Suction and its role
What drain do you take out MARK IT
Rocket bottle
Cardiac drain system
Post operative care
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Blood pressure
Blood gases / saturation
Urine output
Bleeding
Sputum
Analgesia