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Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy

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Presentation of "Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy," by Dr. Conrad Vial, Director of Cardiothoracic Surgery, Mills-Peninsula Health Services.

Presentation of "Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy," by Dr. Conrad Vial, Director of Cardiothoracic Surgery, Mills-Peninsula Health Services.

Published in: Health & Medicine

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  • 1. Lung Cancer: an overview & discussion of minimally invasive surgical therapy Conrad Massimo Vial, MD Director of Cardiothoracic Surgery Mills Peninsula Health System
  • 2.  
  • 3.  
  • 4.  
  • 5.  
  • 6.  
  • 7.  
  • 8. Tumor T1 T2 T3 T4 Nodes N0 N1 N2 N3 IA IB IIB IIIB Stage IV = M1 Stage IIIB and IV generally unresectable Lung Cancer IIIB IIIB IIIB IIIB IIIA IIIA IIIA IIIB IIA IIB IIIA IIIB
  • 9. 5-yr survival for treated NSCLC according to surg-path state: Stage I: ≈ 70% Stage II: ≈ 50% Stage III: ≈ 20%
  • 10. Minimally Invasive Lung Cancer Operations Video Assisted Thoracoscopic (VATS) Lobectomy & Lung Sparing Operations
  • 11. The Traditional Approach Open Thoracotomy
  • 12. Video Assisted Thoracoscopy (VATS)
  • 13. VATS Lobectomy
  • 14.  
  • 15.  
  • 16. Results in the Literature
    • Advantages of VATS Approach . . .
      • Less postoperative pain
      • Shorter length of stay
        • Reduced air leaks/length of chest tube placement
        • Reduced overall hospital cost
      • Faster recovery/return to normal activities
      • Better postoperative pulmonary function
      • More likely to complete postoperative chemotherapy
  • 17. Literature Summary
    • VATS lobectomy offers advantages over conventional thoracotomy without compromise of short term or long term outcome
    • VATS lobectomy can become a cost effective alternative to open lobectomy in the treatment of operable NSCLC
  • 18. Lung Sparing Operations Bronchoplasties & Sleeve Resections
  • 19. Definition of Bronchoplastic Techniques
    • Sleeve Lobectomy
    • vs
    • Bronchial Sleeve Resection
    A A
  • 20.  
  • 21.  
  • 22. Results in the Literature
    • 30 day mortality for all bronchoplastic procedures is 8%
    • Mortality for sleeve lobectomy is 5%
    • Mortality for sleeve pneumonectomy is 20 – 25%
    • Mortality rates double or triple in the presence of;
      • Poor pulmonary function (FEV 1 < 50% predicted)
      • Pulmonary hypertension
      • Severe coronary artery disease
  • 23. What are we doing? What are our results? Conrad M Vial, MD Tomomi Oka, MD
  • 24. Program in CT Surgery Overall Volume & Outcomes 2008-2010 TOTAL CASES = 1216 MORTALITY = 0.7% MAJOR MORBIDITY = 3.9% CARDIAC CASES = 529 MORTALITY = 1.5% MAJOR MORBIDITY = 6.2% THORACIC CASES = 687 MORTALITY = 0.4% MAJOR MORBIDITY = 2.8%
  • 25. Diversity & Complexity of Major Thoracic Operations
  • 26. Diversity & Complexity of Major Thoracic Lung Operations Bronchoplasty and/or Sleeve Resection n=15 Thoracoscopic Lobectomy n=107
  • 27. STS NATIONAL DATABASE Influence of Functional Score in Resections for Lung Cancer ZUBROD SCORE MORTALITY LOS > 14 DAYS COMPLICATIONS 0 1.3% 4.8% 32% 1 1.8% 6.8% 35% 2 3.5% 12% 41% 3 7% 14% 46% 4 16% 21% 51%
  • 28. STS NATIONAL DATABASE Influence of FEV 1 in Resections for Lung Cancer Preop FEV 1 MORTALITY LOS > 14 DAYS COMPLICATIONS > 80% pred 1.1% 4% 30% 61-79% pred 2% 8% 39% < 60% pred 2% 9% 41%
  • 29. Diversity & Complexity of Major Thoracic Operations for Lung Ca Bronchoplasty and/or Sleeve Resection n=15 Thoracoscopic Lobectomy n=107
  • 30. CRUDE Benchmarking “Best Case” vs Non-risk adjusted Best Case Lung Ca Resection STS Scenario Mortality LOS > 14 days Complications Preop FEV 1 > 80% pred & Zubrod Score 0 ~1.2% ~4% ~30%
  • 31. THANK YOU !