Surgical Management Of Lung Cancer

Question 1

How is fitness for surgery calculated?

Answer 1

Fitness for surgery is based on certain conditions from CVS, respiratory system, psych and others, that would regard the patient as unsafe for surgery if they had one of them.
These include:
CVS - angina, carotid bruits, hypertension, heart murmurs, previous angioplasty, stroke?
Resp - recurrent URTI’s, hyper expanded chest, still smoking, on oxygen, asthmatic, previous thoracotomy?
Psych - anxiety, chronic pain problems, low social support, history of mental illness?
Other - permenant tracheostomy, rheumatoid arthritis, immobile patient, cirrhosis to the chest?

Question 2

What are the main causes of post operative death?

Answer 2

Pneumothorax
Pulmonary embolism
Intrathoracic bleeding
Acute respiratory distress syndrome
Myocardial infarction

Question 3

Name two structures that if the lung tumour was attached to, this would deem it inoperable.

Answer 3

Trachea

Mediastinum

Question 4

What blood tests are carried out for the staging of lung cancer?

Answer 4

Renal and liver function
Anaemia
Bone profile
Bronchoscope
Mediastinoscopy

Question 5

What tests can be carried out for determining the stage cancer?

Answer 5

Blood tests
MRI (degree of vascular and neurological involvement in pancoast tumour)
Bone scan (chest wall invasion and bone mets)
ECHO (presence or absence of pericardial effusion)

Question 6

What respiratory functioning tests are carried out for fitness for surgery?

Answer 6

Spirometers
Diffusion studies (measures gas transfer at the alveoli)
V/Q scan
ABG on air/SLV

Question 7

What cardiac functioning tests can be carried out for assessing cardiac function for fitness for surgery?

Answer 7

ECG
ECHO
CT scan (check for pleural effusion, if so then inoperable)
Coronary angiogram
Exercise stress test

Question 8

If there is a pleural effusion is it the tumour still operable?

Answer 8

No

Question 9

what are the non fatal complications from surgery?

Answer 9

wound infection
wound bleeding
respiratory insufficiency
MI
atrial fibrillation
bronchopleural fistula
empyema
constipation

Question 10

what are the fatal complications from surgery?

Answer 10

Acute respiratory distress syndrome
MI
pneumothorax
bronchopneumonia
intrathoracic bleeding
pulmonary thromboembolism