Thoracic surgery
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Thoracic surgeryThoracic surgery
Thoracic Surgery DepartmentThoracic Surgery Department
Regional Hospital for Lung Regional Hospital for Lung DiseasesDiseases
Szczecin Zdunowo, PolandSzczecin Zdunowo, Poland
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Long time agoLong time ago
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Much laterMuch later
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Main carcinogenic factorsMain carcinogenic factors
• ChemicalsChemicals– AsbestosAsbestos– BenzidineBenzidine– methyl etermethyl eter– Vinyl chlorideVinyl chloride– Aromatic Aromatic
hydrocarbonshydrocarbons
CIGARETTE CIGARETTE SMOKINGSMOKING
• Occupational Occupational exposureexposure– Coal gasificationCoal gasification– Hematite and Hematite and
uranium mininguranium mining– Contact with Contact with
arsene, nickel, arsene, nickel, beryl, chromeberyl, chrome
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So called early lung cancer So called early lung cancer symptomssymptoms
• CoughCough
• HemoptysisHemoptysis
• Intrathoracic painIntrathoracic pain
• Recurrent Recurrent pneumoniaspneumonias
Are those Are those symptoms really symptoms really
early?early?
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Paraneoplasmatic Paraneoplasmatic symptomssymptoms• Cushing Cushing
syndromesyndrome
• HipercalcemiaHipercalcemia
• GynaecomastiaGynaecomastia
• PolymyosistisPolymyosistis
• Peripheral Peripheral neuropathyneuropathy
• MyastheniaMyasthenia
• Proliferatic Proliferatic osteoarthropathyosteoarthropathy
• Lupus Lupus erythematosuserythematosus
• Acanthosis Acanthosis nigricansnigricans
• Anaemia, Anaemia, leucopenialeucopenia
• ThrombocytopaenThrombocytopaeniaia
• Thrombophlebitis Thrombophlebitis migransmigrans
• Aseptic Aseptic endocarditisendocarditis
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HistologyHistology
S q u am ou s ce ll ca A d en ocarc in om a C arc in om a m ic roce llu la re
L u n g can cer
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DiagnosisDiagnosis
• RadiologyRadiology: X-ray, CT, : X-ray, CT, NMR, USG, NMR, USG, scintigraphyscintigraphy
• PathologyPathology: sputum : sputum cytology, endoscopy, cytology, endoscopy, FNAB FNAB mediastinoscopy, mediastinoscopy, VATS, explorative VATS, explorative thoracotomythoracotomy
• GeneticsGenetics: p53, k-ras, : p53, k-ras, CEA, cyfra 21-1, mycCEA, cyfra 21-1, myc
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Contraindications for Contraindications for surgerysurgery
• DisseminationDissemination
• Horner`s syndromeHorner`s syndrome
• Vena cava Vena cava syndromesyndrome
• Vocal cord paresisVocal cord paresis
• Pancoast syndromePancoast syndrome
• WHO>2WHO>2
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Surgical approach Surgical approach
• Antero- and anterolateralAntero- and anterolateral
• PosterolateralPosterolateral
• SternotomySternotomy
• ClamshellClamshell
• PaulsonPaulson
• MixedMixed
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Anterior thoracotomyAnterior thoracotomy
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Posterolateral thoracotomyPosterolateral thoracotomy
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SternotomySternotomy
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ClamshellClamshell
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PaulsonPaulson
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MixedMixed
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Types of surgeryTypes of surgery
• PneumonectomyPneumonectomy
• Lobectomy (incl. sleeve)Lobectomy (incl. sleeve)
• SegmentectomySegmentectomy
• Wedge or marginal resectionWedge or marginal resection
• VATSVATS
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Long term survival ratesLong term survival rates
I I IIII IIIIII
40 - 80% 40 - 80%
100%-Japan?100%-Japan?12 - 54%12 - 54% 4 – 33%4 – 33%
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Combined treatmentCombined treatment
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PneumothoraxPneumothorax
• CloseClose
• OpenOpen
• TensionTension
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TreatmentTreatment
• Bed restBed rest
• DrainageDrainage
• PleurectomyPleurectomy
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DrainageDrainage