Thoracic surgeryThoracic surgery
Thoracic Surgery DepartmentThoracic Surgery Department
Regional Hospital for Lung Regional Hospital for Lung DiseasesDiseases
Szczecin Zdunowo, PolandSzczecin Zdunowo, Poland
Long time agoLong time ago
Much laterMuch later
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
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?
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
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
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
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
Surgical approach Surgical approach
• Antero- and anterolateralAntero- and anterolateral
• PosterolateralPosterolateral
• SternotomySternotomy
• ClamshellClamshell
• PaulsonPaulson
• MixedMixed
Anterior thoracotomyAnterior thoracotomy
Posterolateral thoracotomyPosterolateral thoracotomy
SternotomySternotomy
ClamshellClamshell
PaulsonPaulson
MixedMixed
Types of surgeryTypes of surgery
• PneumonectomyPneumonectomy
• Lobectomy (incl. sleeve)Lobectomy (incl. sleeve)
• SegmentectomySegmentectomy
• Wedge or marginal resectionWedge or marginal resection
• VATSVATS
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%
Combined treatmentCombined treatment
PneumothoraxPneumothorax
• CloseClose
• OpenOpen
• TensionTension
TreatmentTreatment
• Bed restBed rest
• DrainageDrainage
• PleurectomyPleurectomy
DrainageDrainage
Top Related