Surgical treatment of lung cancer
Dating

Lung cancer or else the bronchogenic cancer is the most common cancer in male and competes with breast cancer in women in the occupation of the first class. O vronchogenis cancer is the leading cause of death in the list of malignancies, and one in three cancer deaths have been cause lung cancer. The incidence of U.S. shows declining trend while there is an increasing trend worldwide.

Recent years have witnessed great progress in surgical technique and the technique of anesthesia in terms of lung surgery. Also the selection of patients and the preoperative preparation is more accurate and more complete, respectively. The postoperative support of patients undergoing surgical treatment and monitoring, coupled with the invaluable contribution of the Intensive Care Unit contributed significantly to the reduction of perioperative morbidity and mortality.

Despite the progress, in terms of surgery and despite the granting of more effective chemotherapeutic drugs as well, despite the best technique of radiotherapy, the five-year survival remains very low and not exceed 15% of all patients with vronchogeni cancer.

Surgical therapy remains the cornerstone in the treatment of lung cancer and is the only way to address that offers long-term survival, at least as far as patients with cancer early-stage and others were in more advanced stages, after a very rigorous selection.

The type of surgery is applied depends on many factors such as stage of disease, the overall condition of the patient and the cardiopulmonary reserve. The excisions made in the treatment of lung cancer is the wedge resection, the tmimatektomi, formal lovektomi the way of lovektomi cuff (sleeve lobectomy), the formal or pnefmonektomi endoperikardiaki the synexairesi with lung resection of chest wall and the way of pnefmonektomi cuff (sleeve Pneumonectomy). Each response from them has its specific indications, morbidity and mortality which accompanies it.

When the cancer is in stage Ia or Ib or IIa (T1NoMo, T2NoMo and T1N1Mo respectively), the treatment of choice is surgery if the patient's respiratory reserve and allow the treatment choice is less lovektomi the pnefmonektomi ( Figures 1, 2, 3). The perioperative mortality of lovektomis not exceed 1.5%, while the quality of life of these patients is excellent. When the lymph nodes of mesoloviou slit or gate is infiltrated and even more when they are stranded, then surgery is the choice pnefmonektomi. The perioperative mortality after pnefmonektomi is around 6.4%. The contribution of intensive care, the preoperative preparation and postoperative support, played an important role in the significant reduction of perioperative morbidity and mortality. If the volume extends beyond the visceral pleura or the parietal pleura, ie when filters pericardium, diaphragm and chest wall (T3NoMo or T2N1Mo) then the choice is surgery to remove part or all of the affected lung with adjacent anatomical element. It should be noted that the infiltration of the chest wall is not a contraindication of surgical treatment, and when the deficit is created in the chest wall is large (> 5 million), it is imperative to restore it with a graft.

A group of patients with cancer vronchogeni that deserves special attention is the group of patients stage IIIa, the filtration of mediastinal lymph nodes (T1-3N2Mo). Having established the infringement of mediastinal lymph nodes with mesothorakoskopisi, mesothorakotomi, or at least thorakoskopisi PET Scan, then the response is to grant import chemotherapy (NEW - adjuvant) and only if any significant response, then followed by surgical treatment. The granting of import chemotherapy should be based on the findings of CT, but we need to substantiate a breach of the mediastinal lymph nodes with an invasive surgery than those listed above.

Patients with more advanced lung cancer stage IIIB and IV

(T1-4 N1-3 Mo and T1-4 N1-3 M1), are usually unsuitable for surgical treatment except for a few exceptions, and after rigorous selection. When is a new patient in good general condition and excellent cardio-respiratory reserve even have cancer leaches the upper vena cava or left atrium at the outfall of the pulmonary veins (Figures 4, 5, 6) or the strain of pulmonary artery or aorta (limited functionality) or thoracic vertebrae, then it must be assessed seriously the role of surgery. The same applies when there is lung cancer with solitary metastasis to the brain or the adrenal can be removed completely, the role of surgery remains an essential and primary.

Besides the therapeutic role, surgery has an important role palliative treatment. This is particularly true for patients who have a large collection of fluid in the pericardium or the pleural cavity, so it could be perikardiektomi (pericardial window) in the first case half thorax rib cage and drainage followed by plefrodesia the second case.

It can be immediate relief for patients with unresectable volume infiltrate the trachea, the keel or the main loop by placing endoprosthesis (stent), after having been first cauterization of endoaflikou volume using Laser or electrical diathermy or cryopiksia.

Because the percentage of patients may undergo a surgical treatment does not exceed 15 to 20%, the effort to combat this disease, you must concentrate on preventing the main objective the elimination of smoking.

Because this is not easy in practice, it must be serious efforts to increase the number of patients undergoing surgical treatment, the only effective treatment as mentioned above. This can be achieved by evaluating the patient by a panel comprising pulmonologist, oncologist, Thoracic and radiotherapy, to be deprived of no patients the beneficial effect of surgery.

They should also avoid unnecessary thoracotomies as possible and the rate does not exceed the 5 to 10% of the thoracotomy for lung cancer. In addition to be reduced even further the postoperative morbidity and mortality. This reduction can be achieved when there is close cooperation between Thoracic, pulmonologist, cardiologist and Medical Intensive Care Unit. Also, surgical patients need to be hospitalized for 24 hours in ICU and the surgeon is highly suspicious in regard to fatal complications.

Another important objective should be to find new more effective therapies and treatments they are depending on the tissue type and taking into account specific parameters than those that are available to us today.



Figure 1: Opisthioprosthia young patient's chest radiograph showing

sizable shadow in the left portal lung

Figure 2: CT scan of the same patient in Figure 1. Sizable volume

the left upper lobe.

Figure 3: Postoperative radiograph of the chest at the top left

lovektomi for non-small cell lung cancer. Fully expanded

the left lower lobe which occupies the left full

half thorax.

Figure 4: Opisthioprosthia chest radiograph. Sizable shadow of the left

lower lobe

Figure 5: Computed tomography of thoracic patient FIGURE 4. Sizable

left lower lobe mass extending to the left atrium

Figure 6: The surgical preparation, the entire left lung. The

volume of claims in the left lower pulmonary vein. It has become

resection of the left bay of the outfall

pulmonary vein, then it seems the pericardium.