1 / 63

Thoracic Surgery Innovations And Complications

Thoracic Surgery Innovations And Complications . Overview. Innovations Complications. Innovations. VATS LVRS Chemotherapy Radiotherapy PET Small Cell N2 Stents & Lasers Stapler In Oesophagogastrectomy Epidural SVC stents. Complications. ?. Complications. Air Leak Atalectasis

leena
Download Presentation

Thoracic Surgery Innovations And Complications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Thoracic SurgeryInnovations AndComplications

  2. Overview • Innovations • Complications

  3. Innovations • VATS • LVRS • Chemotherapy • Radiotherapy • PET • Small Cell • N2 • Stents & Lasers • Stapler In Oesophagogastrectomy • Epidural • SVC stents

  4. Complications ?

  5. Complications • Air Leak • Atalectasis • Sputum Retention • Chest Infections • Atrial Fibrillation • Bleeding • Wound Infections • Recurrent Disease • Inadequate Resection • Medical Problems • MRSA • Bronchopleural Fistula • Post Pneumonectomy Problems • Post Pneumonectomy Empyema • Lobectomy Space Problems

  6. Innovations

  7. VATS • Sympathectomy • Pleurectomy • Lobectomy • Biopsy • mass • lung

  8. Pneumothorax

  9. Pleurectomy • VAT • Muscle sparing • Mini • Full Thoracotomy

  10. VAT Lobectomy

  11. Biopsy Lung / Pleura

  12. LVRS

  13. LVRS

  14. LVRS • Criteria • Dyspnoeic on daily activities • Age < 75 • No bullae > 5cm • Generalised emphysema with regional heterogeneity • TLC > 125% • FEV1 < 30 % • PaCO2 < 50 mmHg, PaO2 > 40 mmHg on air • No CAD or Pulmonary hypertension • Steroid < 15 mg/day

  15. LVRS • Unilateral / Bilateral • Thoracotomy / Sternotomy / VAT • Role of Physio

  16. Chemotherapy and Radiotherapy • Preoperative Neoadjuvant • Operative • Postoperative Adjuvant

  17. Chemotherapy • Numerous agents • Adjuvant • No evidence • Role in N2 disease • All oat cell • Neoadjuvant • Stage IIIA (N2) • If respond are resected • No residual tumour at surgery means prolonged survival • Experimental

  18. Radiotherapy • External beam external rays • Single / multiple beam / Fraction No • Brachy local ie intra bronchial • Interstitial directly into tumour • Intra cavity in bronchus • Adjuvant Postoperative • Neoadjuvant Preoperative

  19. Radiotherapy • Primary treatment • Stage 1 and 2 • Refuse or unfit for surgery • Failure 30 % stage 1, 70% stage 2 • 5 year survival 5 to 40% • Adjuvant for N1 / N2 • Reduces rate local recurrence • Survival unchanged • ? Role in +Ve resection margins

  20. Radiotherapy • Neoadjuvant • T3 Pancoast prior to surgery • Palliative • Symptomatic relief • Pain, haemoptysis, bronchial, SVC obstruction • Bone met pain • Brachytherapy • Local application high local dose

  21. Chemotherapy and Radiotherapy • Adjuvant • Neoadjuvant • Sequential / concurrent / alternating • Good performance status • Not standard practice • May increase risk surgery

  22. PET • 2-(fluorine-18) fluo-2-deoxy-D-glucose (18-FDG) • 18-FDG competes with glucose for facilitated transport into tumour cells and also competes with glucose for phosphorylation by hexokinase • Positive and negative predictive power

  23. Small Cell Lung Cancer

  24. Small Cell All need : Mediasteinoscopy CT head Bone scan

  25. Pre operative N2 • Young patients • Pre op chemo downstage • No evidence

  26. Stents & Lasers Malignant terminal conditions that are inoperable Benign inoperable conditions

  27. Tracheal obstruction-malignant - Pre and post Nd:Yag laser

  28. Left main bronchus extensive squamous cell carcinoma Metal stent in left main

  29. Stapler In Oesophagogastrectomy

  30. Epidural • Pain • Poor PFTs • Cardiac history • Contraindications • Low risk • On anticoagulants • Consent • Anatomical • Infective

  31. SVC Stents

  32. Complications

  33. AIR LEAK

  34. AIR LEAK • What operation • Aetiology • Conservative • Talc • Tetracycline • Blood • Flutter bag • Sort out in Theatre saline, bagging and prolene

  35. Atelectasis • Obstructive tumour, mucous or foreign body • Non obstructive effusion or mass • Pain • Double lumen tube malposition • Temperature • WCC • TNF alpha • Nebs • Physio • Bronch

  36. Sputum Retention • Pain • Phrenic nerve block • Anatomical stenosis • Surgical, • Foreign body, • Tumour • Preoperative sputum and smoking • Physio, Nebs, stop smoking, pain relief- epidural, pre op admission for a week

  37. Chest Infections • Frequent • Pre op PFTs and performance predict • Medical and surgical causes • Pre op cultures from bronch • Pain relief, Nebs, Antibiotics and Physio

  38. Atrial Fibrillation • pO2, K+ • Intrapericardail dissection • Pneumonectomy > lobectomy > wedge • Chest infection / Atelectasis • Role digoxin prophylaxis • Beta blockers • Oesophageal leak

  39. Bleeding • Should be rare unless on anticoagulants • Usually massive or from chest wall • Probably little role for platelets, FFP or Aprotinin • CXR most helpful, if collecting TAKE BACK

More Related