Figures
- Figure 1.
Segmentectomy performed using video-assisted thoracic surgery. a) Chest computed tomography of a 68-year-old patient showing a 13-mm nodule in the lingula segment, near the oblique fissure. b) Videothoracoscopic view showing the nodule. Frozen sections revealed a primary lung adenocarcinoma and segmentectomy was started. The lingula segmental artery (c) and the segmental vein (d) were dissected and stapled. The segmental bronchus was divided (e) and stapled, the fissure was opened with an endolinear stapler and the segmentectomy completed. The specimen was extracted within a protective bag. Macroscopic inspection showed a surgical margin >15 mm (f).
- Figure 2.
A left pancoast tumour. a) Chest magnetic resonance imaging of a left pancoast tumour arising in the left upper lobe and infiltrating the first rib, brachial plexus and left subclavian artery. The patient received induction chemoradiotherapy: three cycles of vinorelbin and cisplatin, as well as 45 Gy. He underwent en bloc resection through sternotomy and supraclavicular approach, the left upper lobe and the three first ribs were removed and the left subclavian artery was reconstructed. The left phrenic and vagus nerves had to be sacrificed. Histopathology showed a primary lung adenocarcinoma with >90% necrosis. b) Chest radiography of the same patient 4 years post-operatively. There is obvious left phrenic nerve palsy. The patient had a positron emission tomography-computed tomography scan at 5 years which showed no sign of relapse.
- Figure 3.
Right sleeve pneumonectomy for T4 squamous cell carcinoma. a) Chest computed tomography (CT) showing squamous cell carcinoma infiltrating the right main bronchus and carina, with marked obstructive changes and bronchiectasis in the right lower lobe. The right pulmonary artery was infiltrated as well. Cervical mediastinoscopy was performed and showed no invasion of lymph node stations 2R, 4R, 3 and 7. Positron emission tomography-CT showed no distant metastases. The patient was offered extended right pneumonectomy. He developed bronchopleural fistula and had an open pleural window 6 weeks post-operatively. b). He underwent reconstructive thoracoplasty at 2 years and remains disease-free at 4 years, with secondary pulmonary hypertension (c).
Tables
- Table 1. TNM (tumour, node, metastasis) classification for lung cancer
Primary tumour (T) TX Primary tumour cannot be assessed, or the tumour is proven by the presence of malignant cells in sputum or bronchial washing but is not visualised by imaging or bronchoscopy T0 No evidence of primary tumour Tis Carcinoma in situ T1 Tumour ≤3 cm in greatest dimension, surrounded by lung or visceral pleura, no bronchoscopic evidence of invasion, more proximal than the lobar bronchus (not in the main bronchus); superficial spreading of tumour in the central airways (confined to the wall of the trachea or mainstem bronchus) T1a Tumour ≤2 cm in the greatest dimension T1b Tumour >2 cm but ≤3 cm in the greatest dimension T2 Tumour >3 cm but ≤7 cm or tumour with any of the following:
Invades visceral pleura
Involves the main bronchus ≥2 cm distal to the carina
Associated with atelectasis/obstructive pneumonitis extending to hilar region but not involving the entire lungT2a Tumour >3 cm but ≤5 cm in the greatest dimension T2b Tumour >5 cm but ≤7 cm in the greatest dimension T3 Tumour >7 cm or one that directly invades any of the following:
Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium
Tumour in the main bronchus <2 cm distal to the carina but without involvement of the carina
Associated atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobeT4 Tumour of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, or carina
Separate tumour nodule(s) in a different ipsilateral lobeRegional lymph nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional node metastasis N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension N2 Metastasis in the ipsilateral mediastinal and/or subcarinal lymph node(s) N3 Metastasis in the contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes Distant metastasis (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis M1a Separate tumour nodule(s) in a contralateral lobe; tumour with pleural nodules or malignant pleural (or pericardial) effusion M1b Distant metastasis Reproduced from [18] with permission from the publisher.
- Table 2. Anatomic stage/prognostic groups
Stage T N M Ia T1a N0 M0 T1b N0 M0 Ib T2a N0 M0 IIa T1a N1 M0 T1b N1 M0 T2a N1 M0 T2b N0 M0 IIb T2b N1 M0 T3 N0 M0 IIIa T1 N2 M0 T2 N2 M0 T3 N2 M0 T3 N1 M0 T4 N0 M0 T4 N1 M0 IIIb T4 N2 M0 T1 N3 M0 T2 N3 M0 T3 N3 M0 T4 N3 M0 IV T any N any M1a or 1b T: tumour; N: node; M: metastasis. Reproduced from [18] with permission from the publisher.
- Table 3. Overall survival benefit of adjuvant chemotherapy
Trial Patients n Stage 5-year survival benefit, % Hazard ratio (95% CI) p-value ALPI 1209 I–IIIA 3 0.96 (0.81–1.13) 0.589 IALT 1867 I–IIIA 4 0.91 (0.81–1.02) 0.03 BLT 381 I–IIIA 2 1.02 (0.77–1.35) 0.90 BR10 482 IB–II 15 0.69 (0.52–0.91) 0.04 ANITA 840 IB–IIIA 9 0.8 (0.66–0.96) 0.017 LACE 4584 I–IIIA 5 0.89 (0.82–0.96) 0.004 IGR-MRC 8147 I–IIIA 4 -0.87 (0.81–0.93) <0.0000001 Reproduced from [3] with permission from the publisher.
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- Article
- Abstract
- Introduction
- Clinical and surgical staging
- Assessment of the risk for surgery
- Types of procedures and approaches
- Extended lymphadenectomy versus lymph node sampling
- Surgery for early stage lung cancer (stage I and II)
- Surgery for stage IIIa and IIIb lung cancer
- Surgery for stage IV lung cancer (solitary metastasis)
- Reoperations for cancer and completion pneumonectomy
- Surgery in the elderly
- Lung resections in HIV-positive patients
- Surgery in patients with impaired pulmonary function
- Impact of surgical volume and surgeon's specialty on outcomes in lung cancer surgery
- Palliative surgery
- Conclusion
- Footnotes
- References
- Figures & Data
- Info & Metrics