Non small cell lung cancer surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. Common surgical procedures for the treatment of non-small cell lung cancer, include lung resection with lobectomy, lung resection with pneumonectomy with or without lymph node dissection. The preferred surgical procedure is thoracotomy with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes and contiguous structures. | Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. Common surgical procedures for the treatment of non-small cell lung cancer, include lung resection with [[lobectomy]], lung resection with [[pneumonectomy]] with or without lymph node dissection. The preferred surgical procedure is [[thoracotomy]] with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes and contiguous structures. | ||
==Surgery== | ==Surgery== | ||
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*Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. | *Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. | ||
*Common surgical procedures for the treatment of non-small cell lung cancer, include: | *Common surgical procedures for the treatment of non-small cell lung cancer, include: | ||
:*Lung resection with lobectomy | :*Lung resection with [[lobectomy]] | ||
:*Lung resection with pneumonectomy with or without lymph node dissection | :*Lung resection with [[pneumonectomy]] with or without lymph node dissection | ||
:*The preferred surgical procedure is thoracotomy with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes (peribronchial and perihilar [[lymph node]] dissection) and pathological evaluation. | :*The preferred surgical procedure is [[thoracotomy]] with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes (peribronchial and perihilar [[lymph node]] dissection) and pathological evaluation. | ||
*If evidence of [[lymph node]] extension of the disease is present | *If evidence of [[lymph node]] extension of the disease is present [[adjuvant chemotherapy]] should be administered | ||
*Surgical resection is not recommended for patients with advanced or metastatic non-small cell lung carcinoma | *Surgical resection is not recommended for patients with advanced or metastatic non-small cell lung carcinoma | ||
*Surgical staging of the mediastinum is considered standard if accurate evaluation of the nodal status is needed to determine therapy | *Surgical staging of the mediastinum is considered standard if accurate evaluation of the nodal status is needed to determine therapy | ||
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*The best results are found in squamous cell carcinoma followed by large-cell carcinoma and the adenocarcinoma. | *The best results are found in squamous cell carcinoma followed by large-cell carcinoma and the adenocarcinoma. | ||
*If the pathological evaluation of the dissected [[lymph nodes]] is positive to malignant neoplastic cells, the patient should be treated according to the [[Non-small cell carcinoma of the lung medical therapy stage III|Stage III]] treatment algorithm. | *If the pathological evaluation of the dissected [[lymph nodes]] is positive to malignant neoplastic cells, the patient should be treated according to the [[Non-small cell carcinoma of the lung medical therapy stage III|Stage III]] treatment algorithm. | ||
*If the [[tumor]] is inoperable, [[ | *If the [[tumor]] is inoperable, [[Stereotactic radiosurgery|stereotactic ablative radiation therapy]] should be administered. | ||
==Indications== | ==Indications== | ||
Revision as of 23:39, 23 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Surgery is the mainstay of therapy for early-stage non-small cell lung cancer. Common surgical procedures for the treatment of non-small cell lung cancer, include lung resection with lobectomy, lung resection with pneumonectomy with or without lymph node dissection. The preferred surgical procedure is thoracotomy with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes and contiguous structures.
Surgery
In non-small cell lung cancer, surgical procedure selection will depend on the histology, margins, and size of the tumor.[1][2]
- Surgery is the mainstay of therapy for early-stage non-small cell lung cancer.
- Common surgical procedures for the treatment of non-small cell lung cancer, include:
- Lung resection with lobectomy
- Lung resection with pneumonectomy with or without lymph node dissection
- The preferred surgical procedure is thoracotomy with the removal of the entire lung or lobe (lobectomy) along with regional lymph nodes (peribronchial and perihilar lymph node dissection) and pathological evaluation.
- If evidence of lymph node extension of the disease is present adjuvant chemotherapy should be administered
- Surgical resection is not recommended for patients with advanced or metastatic non-small cell lung carcinoma
- Surgical staging of the mediastinum is considered standard if accurate evaluation of the nodal status is needed to determine therapy
- Surgical treatment consists of a thoracotomy with removal of the entire lung or lobe along with regional lymph nodes and contiguous structures
- Pneumonectomy is used if the tumor involves the main bronchus, extends across a fissure or is located such that wide excision is required.
- Survival following ‘curative’ resection is approximately 30% at 5 years and 15% at 10 years.
- The best results are found in squamous cell carcinoma followed by large-cell carcinoma and the adenocarcinoma.
- If the pathological evaluation of the dissected lymph nodes is positive to malignant neoplastic cells, the patient should be treated according to the Stage III treatment algorithm.
- If the tumor is inoperable, stereotactic ablative radiation therapy should be administered.
Indications
Non-small cell lung cancer surgery is usually reserved for patients with the following characteristics:[1]
- Pulmonary function testing
- Exercise testing
- Successful cutoff of 22 m on the stair climbing test
- Fitness for surgery
- Evaluation of risk factors, such as:
- Age
- General health status (obesity, Karnofsky scale >70)
- COPD/Asthma
- Smoking
- Other conditions: pulmonary hypertension, heart failure, and metabolic factors
Contraindications
Non small cell lung cancer surgery is usually contraindicated in patients with the following characteristics:[2]
- Non-small cell lung cancer extension past the diaphragm
- Extrathoracic metastases
- Metastases to supraclavicular lymph nodes
- Contralateral mediastinal node metastases
- Involvement of contralateral hemithorax
- Invasion of structures of the mediastinum
- Involvement of the main pulmonary artery
- Chest wall invasion
- No fitness for surgery
- Hypercapnia (arterial PCO2 greater than 45 mmHg)
- Inadequate exercise testing results (22 m on the stair climbing test)
- Presence of oncological emergencies, such as superior vena cava syndrome, malignant pleural effusion, cardiac tamponade, vocal cord or phrenic nerve paralysis
Complications
Common complications of non small cell lung cancer surgery, include:[2]
- Prolonged mechanical ventilation
- Respiratory failure
- Bronchospasm
- Pulmonary embolism
References
- ↑ 1.0 1.1 von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT (2011). "Functional evaluation before lung resection". Clin. Chest Med. 32 (4): 773–82. doi:10.1016/j.ccm.2011.08.001. PMID 22054885.
- ↑ 2.0 2.1 2.2 Smetana GW, Lawrence VA, Cornell JE (2006). "Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians". Ann. Intern. Med. 144 (8): 581–95. PMID 16618956.