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Surgical Aspects in Lung Cancer Management

Surgical Aspects in Lung Cancer Management. Mike Poullis CTC Liverpool. Surgical Aspects in Lung Cancer Management. How fit is the patient ? What is the stage, histology, and exact size and location ? Is the patient for Diagnosis Treatment Palliation. Overview. Diagnostic Bronchoscopy

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Surgical Aspects in Lung Cancer Management

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  1. Surgical Aspects in Lung Cancer Management Mike Poullis CTC Liverpool

  2. Surgical Aspects in Lung Cancer Management • How fit is the patient ? • What is the stage, histology, and exact size and location ? • Is the patient for • Diagnosis • Treatment • Palliation

  3. Overview • Diagnostic • Bronchoscopy • VATS • Mediasteinoscopy • Mediasteinotomy • Treatment • Wedge • Lobectomy • Combined wedge and lobectomy • Pneumonectomy • Palliation • Effusions

  4. Diagnostic: Bronchoscopy

  5. Diagnostic: Bronchoscopy • Rigid and flexible scope • Biopsy and selective washings • Larger samples than flexible scope • Exact location • Lobectomy • Pneumonectomy • Unresectable • Sleeve

  6. Diagnostic: Bronchoscopy

  7. Diagnostic: VATS (Video Assisted Thoracic Surgery) • Diagnosis of pleural disease

  8. Diagnostic: VATS

  9. Mediasteinoscopy & Mediasteinotomy Different lymph node stations

  10. Mediasteinoscopy & Mediasteinotomy

  11. Mediasteinoscopy & Mediasteinotomy • Different surgical cuts

  12. Diagnostic: Mediasteinoscopy & Mediasteinotomy • Diagnoses unresectable disease • Eliminate N2 disease from surgical resection

  13. Surgical Assessment • How fit is the patient ? • What is the • stage, • histology, • exact size and • location ?

  14. How Fit Is the Patient ? • Performance status • Pulmonary function tests • Age • Medical and surgical conditions • What operation do they need

  15. Stage • Assuming fit patient • Can and should you take it out • N2 or N3 disease • T4 disease

  16. Histology • Eliminate benign disease • Beware false negative biopsy • Beware scar cancers • Eliminate small cell patients

  17. Exact size and location ? All T1N0 non small cell carcinoma

  18. Treatment • Wedge • Lobectomy • Combined wedge and lobectomy • Pneumonectomy

  19. Thoracotomy • Posterolateral • Anterolateral • Lateral • Mini • Muscle sparing

  20. Incision

  21. Treatment: Wedge

  22. Treatment: Wedge • Small nodules in poor pulmonary function patients

  23. Treatment: Lobectomy • Gold standard • Left LUL, LLL, • Right RUL+/-RML, RLL+/-RML, RML • Never RUL and RLL

  24. Treatment: Lobectomy

  25. Treatment: Pneumonectomy • Extensive tumours only • Intrapericardial or extrapericardial

  26. Outcomes After Surgery

  27. Chemotherapy and Radiotherapy • Adjuvant • Neoadjuvant • Down staging • Unexpected N2, or positive margins • All small cell

  28. Small Cell • Small nodule needle biopsy shows small cell • If bone scan, and CT head negative refer • If mediasteinoscopy negative then ? Surgical resection

  29. Palliation • Pleural effusions • Drainage, and pleurodesis • Pleurectomy • Talc • Noxious chemotherapeutic agent • Decortication • Removal of tumour mass surrounding lung in pleural space • BENIGN DISEASE DIFFERENT

  30. Any Questions ?

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