This document discusses the evaluation, staging, surgical treatment options, complications, and prognosis for lung cancer. Key points include: - Evaluation involves imaging like CT scans, biopsies, and pulmonary function tests. Surgery is indicated for early stage tumors. - Surgical options include lobectomy, pneumonectomy, wedge resection or segmental resection depending on tumor size and location. - Complications can include air leaks, infection, hemorrhage or formation of a bronchopleural fistula. Outcomes depend on cancer cell type and stage, with earlier stage having higher 5-year survival rates.

2.  Comp history & physical exam
 Lung function tests –spirometry
 Radiograph of chest & suspicious bony lesions
 Blood coagulation tests like BT/CT/PT
 CT scan of thorax, abdomen & brain
 Bronchoscopy
 Surgical evaluation of mediastinum at
mediastinoscopy or at thoracotomy
 PET-Positron emission tomography

3.  Chronic bronchitis
 Excessive obesity
 Barrel shaped chest
 Bronchospasm

4.  Fit patient
 No evidence of spread of tumour outside the
chest
 No clinical or investigatory evidence of
inoperability
 Tumour graded up to T2,N1,M0 are indicated
for surgical resection

5.  Reduction of bronchial infection
 Reduction of bronchospasm
 Deep breathing exercise instructed by
physiotherapist
 Arrangement 3-4pints of compatible blood
transfusion
 Consent-which also includes the consent for
death on table

6.  Tumour inability to separate from aorta/sup vena
cava
 Inability to separate from lower end of trachea
 Spread of tumour along the pulm vein to left
atrium
 Spread along the pulmonary artery
 Involvement of the oesophagial mucosa
 Contalateral/supraclavicular node involvement
 Malignant pleural/pericardial effusion
 Phrenic nerve,recurrent laryngeal nerve
involvement

7. Thoracotomy thoracoscopy

8. A thoractomy is performed to
diagnose lung cancer, remove
lung cancer, and for other
benign conditions. It is mainly
performed in early stage non-
small cell lung cancer
patients.

9.  A double lumen endotracheal tube is used to
ventilate one lung keeping the other collapsed
to facilitate surgery
 Patient is turned on unaffected side in lateral
position keeping upper arm supported in
90”flexion & lower limb flexed at hip & knee
 Posterolateral incision is taken for best
exposure allowing hilium to be approached
both in front & behind
 Rib spreader is inserted following the
approximation of subcutaneous tissues &
muscles


10.  The anesthetist is now
able to deflate the
affected lung for better
view of intrathoracic
structures
 Finally the appropriate
surgical method for
resection of tumour is
performed

11. 1. Pneumonectomy
2. Lobectomy
3. Wedge resection
4. Segmental resection
5. Sleeve lobectomy

12.  Surgical resection
 Surgical resection with
complete mediastinal
lymph node dissection
 En block resection of
tumour with involved
chest wall
 Sleeve resection or
pneumonectomy
Stage IA,IB,IIA,IIB
& some IIIA
Stage IIIA
• Tumours with chest wall
invasionT3
• Sup sulcus tumours
• Proximal airway involvt

13. • Stage IIIA,IIIB,N2
• Stage IIIB + carinal
invasion T4 Without N2
involt
 Rt & chemotherapy
 Pneumonectomy with
tracheal sleeve
resection with direct
reanastomosis of
contralat mainstem
bronchus

14. Surgical removal of a lobe
of a lung
Indication
1. Peripheral growth but
confined to one lobe
2. Patient unfit for
pneumonectomy for
elderly age& impaired
lung function

15.  Following dissection of fissures & hilar
structures in thoracotomy the branches of
pulmonary artery & vein is isolated & ligated
 The bronchus is later sewn or stapled
 After the completion of operation the
remaining lung is reinflated

16. it is the surgical removal of a
small portion of the lung
along with healthy tissue
that surrounds the lung.
It is carried out by
thoracoscopy or VATS
The newer methods are
excision of portion of lobes
using stapling
devices,cautery or laser
ablation

17. Surgical removal of a lobe
along with some part of
the involved bronchus
Indication-a tumor arising
at the origin of a lobar
bronchus precluding
simple lobectomy, but
not infiltrating as far as
to require
pneumonectomy.

18.  It is a most valuable procedure in cases
wherein the growth involves a part of
bronchus
 Here a sleeve of the main bronchus is removed
with the lobe & the two ends of the main
bronchus are re-anastomosed

19. It is the surgical removal of one or
more bronchopulmonary
segments of an individual lobe
through ligation & division of
bronchopulmonary structures
Indication-localized peripheral
tumour in an elderly patient
with poor respiratory function

20.  When a segment is to be resected the
appropriate segmental artery & bronchus are
divided at the hilium & clamp is then placed at
the distal end of bronchus
 The remaining lung is inflated by increasing
endotracheal pressure

21. It is the surgical removal of
the whole lung
Indication
1. Tumours involving many
lobes but confined to the
lung
2. Centrally tumours
involving the main
bronchus or those that
straddle the fissures

22.  Standard pneumonectomy
 Extended radical pneumonectomy
Here the pulmonary artery is first dissected ,
divide & sutured followed by superior or
inferior pulmonary vein
Finally the main bronchus is divided keeping in
mind no blind stump remains to prevent
bronchoplueral fistula.
Mortality rate is 5-10%

23.  A type of minimally
invasive surgery
 it is used to detect
stage, and/or remove
lung cancer.
 3 1/4-1/2” incisions are
made between ribs &3
ports are inserted to
hold instruments.

24. VATS
 here a camera is
attached to the
thoracoscope with the
image displayed on
television screen
 pneumonectomy ,
lobectomy & empyema
drainage are possible

25. Advantages of thoracoscopy
over thoracotomy
 Mean blood loss is less
 No intraoperative death cases or any major
complications
 Shorter hospitalization
 Lesser post operative pain
 Lesser postoperative complication
 Less impairment of pulmonary functions
 Better quality of life

26. Principle
After lobectomy/ segmental resection
• Early expansion of remainder of lung
• Prevent trachobronchial infection
• Efficient physiotherapy
• Fluid overload to be avoided
• Mobilization in 2-3days
• Breathing exercise

27.  Expectoration-actively encouraged
 Analgesics-to relieve pain & increase
expectoration
 Postural draining
 Antibiotic cover
 Ambulation
 Chest tube management

28. 4 strategies
1. Patient controlled analgesia with I V bolus
opiates
2. Paravertebral,extraplueral catheter delivered
3. Oral analgesic& paracetamol
4. Avoid rib fracture & entrapment of intercostal
nerves to prevent chronic unavoidable pain

29.  Large calibre 24-28F Intercostal
drains inserted by making exit
site thr 7th-8th intercostal space
 Apical drain & Basal drain
 The intercostal tubes are
connected to underwater seal
 The tube is clamped & released
every hourly for 1min &
draining is noted
 Tube is removed after 24hrs
 Suction should never be
performed

30. Early
 Sputum retention
 Atrial fibrillation
 Bronchospasm
 Surgical emphysema
 Hemorrhage
 Persistent air leak
Late
 Empyema
 Bronchoplueral fistula

31.  Serious complication
 Following
pneumonectomy the
space left behind is
initially filled with air
which gradually gets filled
with tissue fluid
 Dehiscence of bronchial
stump leads to fistula
formation & the fluid is
expectorated in large
quantities

32. • In order to avoid bronchoplueral fistula the
bronchus is divided close to the trachea or
adjacent lobar bronchus
• The bronchial stump is usual stapled after
pneumonectomy
• Postoperatively the patient is nursed sitting up
turned to affected side to prevent infected
fluid entering remaining lung & use of chest
drain

33. Mortality according to cell
types
Carcinoma 5-Years survival rates
Squamous cell carcinoma 35-50%
Adenocarcinoma 25-45%
Adenosquamous
carcinoma
20-35%
Undifferentiated
carcinoma
15-25%
Small cell carcinoma 0-5%

34. Stage
Stage I
Stage II
Stage IIIa
Stage IIIb,IV
Treatment
Surgery followed by chemotherapy
Surgery followed by chemotherapy
& radiation
Surgery followed by radiotherapy
with/without chemotherapy before
or after surgery
Surgery for lung tumour & brain
tumour
5-year survival rates
60 to 70%
40 to 50%
15 to 30%
10 to 15%