Surgical management of lung cancer

Question 1

Which clinical complications will exclude a patient from surgical consideration?

Answer 1

1. Pleural effusion
2. Chest wall invasion
3. Phrenic nerve palsy
4. Collapsed lobe/lung
5. Bone marrow involvement
6. Diaphragmatic involvement
7. Normal bronchial margins of <2cm
8. Carina involvement
9. node involvement

Question 2

What can be used to identify chest wall and bone invasion?

Answer 2

isotope bone scan

Question 3

What is a cardiac echo useful for identifying in patients being considered for lung cancer resection

Answer 3

Pericardial effusion

Question 4

Nam the 4 lung function tests that patients will go through to assess their fitness for surgery

Answer 4

• Spirometry
• Diffusion studies
• ABG on air/SLV
• Fractionated V/Q scan

Question 5

What is the goal of surgical lung cancer resection?

Answer 5

Cure

Question 6

What is a lobectomy?

Answer 6

Resection of a lobe

Question 7

What is a pneumectomy?

Answer 7

Entire lung is resected

Question 8

What is a wedge resection?

Answer 8

removal of localised tumour using staple guns

Question 9

What is a segmentectomy?

Answer 9

dissect out the segmental artery and bronchus and divided them surgically

Question 10

What is the most common cause of post-operative death?

Answer 10

Adult respiratory distress syndrome due to interstitial lung disease

Question 11

What are the operative mortalities associated with;

1. Pneumonectomy
2. Lobectomy
3. Wedge resection

Answer 11

1. 5-10%
2. 3-5%
3. 2-3%

Question 12

Name 4 things that are often mistaken for a tumour and resected inappropriately

Answer 12

1. Infection (e.g. TB/abscess)
2. Benign tumour (e.g. hamartoma)
3. Granuloma (e.g. sarcoid)
4. Fibrosis