Transcript Surgical Management of Lung Cancer

Surgical Management of Lung
Cancer
By Michael Shackcloth
• Except for small cell carcinoma of the lung
it is generally accepted that surgery is the
most effective therapy for lung carcinoma
– Kirsch Ann Thorac Surg 1976
– Mountain CF Sem Oncol 1983
History
• 1821 Milton Anthony - deliberately opened the
chest
• 1909 Meltzer and Auer - intratracheal
intubation
• 1933 Graham and Singer first pneumonectomy
for lung cancer
• 1950 Churchill proposed lobectomy was safer
and as effective cure for lung cancer
Assessment of Patient
• Fitness for surgery
• Operability of the tumour
The Right Lung
The Left Lung
Bronchial system
Adenocarcinoma
Squamous cell cancer
Large cell Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
UICC Stage of Lung Cancer
IV:
Any T,
Any N,
M1
Synchronous
tumours in
different lobes are
M1
Staging Lung Cancer - bronchoscopy
Staging Lung Cancer - Mediastinoscopy
Staging Lung Cancer - Mediastinotomy
Staging Lung Cancer - Mediastinotomy
Staging Lung Cancer - Thoracoscopy
Thoracotomy
Thoracotomy - Posterolateral
Fitness for Surgery
• Age
• Pulmonary function
• Cardiovascular function
• Nutritional Status
Operability
• Diagnosis and stage
• Operations available
• Adjuvant treatment
• Locally advanced disease
• Small cell lung cancer
Fitness for Surgery
Age
• Perioperative morbidity increases with age
• Surgery for clinically stage I and II disease
is as effective for patients over 70 years old
compared to younger patients
• Age over 80 is not a contraindication to
lobectomy or wedge resection
• Pneumonectomy is associated with a higher
mortality risk in the elderly. Age should be a
factor in deciding suitability for
pneumonectomy
Pulmonary Function
Assessment of Operability
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CT scan
Bone scan
PET scan
Mediastinoscopy
Anterior Mediastinotomy
VATS
Thoracotomy - Anterolateral
Open lung biopsy
Lung Resection – Pneumonectomy
Lung Resection – Lobectomy (RUL)
Lung Resection – Lobectomy (RUL)
Lung Resection – Other operations
• Sublobar resections Segmentectomy
Wedge resection
• Bronchoplasty / Sleeve lobectomy
• Carinal resections – 10 to 12% mortality
•Chest wall resections
Sleeve Resections
Sleeve Resection
Sleeve Resection
Sleeve Resection
Sleeve Resection
Sleeve Resection
Small Cell Lung Cancer
Video Assisted Thoracic Surgery