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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.

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Surgical Management of Lung Cancer

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  1. Surgical Management of Lung Cancer By Michael Shackcloth

  2. 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

  3. 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

  4. Assessment of Patient • Fitness for surgery • Operability of the tumour

  5. The Right Lung

  6. The Left Lung

  7. Bronchial system

  8. Adenocarcinoma

  9. Squamous cell cancer

  10. Large cell Cancer

  11. UICC Stage of Lung Cancer

  12. UICC Stage of Lung Cancer

  13. UICC Stage of Lung Cancer

  14. UICC Stage of Lung Cancer

  15. UICC Stage of Lung Cancer

  16. UICC Stage of Lung Cancer

  17. UICC Stage of Lung Cancer IV: Any T, Any N, M1 Synchronous tumours in different lobes are M1

  18. Staging Lung Cancer - bronchoscopy

  19. Staging Lung Cancer - Mediastinoscopy

  20. Staging Lung Cancer - Mediastinotomy

  21. Staging Lung Cancer - Mediastinotomy

  22. Staging Lung Cancer - Thoracoscopy

  23. Thoracotomy

  24. Thoracotomy - Posterolateral

  25. Fitness for Surgery • Age • Pulmonary function • Cardiovascular function • Nutritional Status

  26. Operability • Diagnosis and stage • Operations available • Adjuvant treatment • Locally advanced disease • Small cell lung cancer

  27. Fitness for Surgery

  28. 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

  29. Pulmonary Function

  30. Assessment of Operability • CT scan • Bone scan • PET scan • Mediastinoscopy • Anterior Mediastinotomy • VATS

  31. Thoracotomy - Anterolateral

  32. Open lung biopsy

  33. Lung Resection – Pneumonectomy

  34. Lung Resection – Lobectomy (RUL)

  35. Lung Resection – Lobectomy (RUL)

  36. Lung Resection – Other operations • Sublobar resections - Segmentectomy • Wedge resection • Bronchoplasty / Sleeve lobectomy • Carinal resections – 10 to 12% mortality • Chest wall resections

  37. Sleeve Resections

  38. Sleeve Resection

  39. Sleeve Resection

  40. Sleeve Resection

  41. Sleeve Resection

  42. Sleeve Resection

  43. Small Cell Lung Cancer

  44. Video Assisted Thoracic Surgery

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