January 30, 2023

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Something important about surgical treatment of lung cancer

Something important about surgical treatment of lung cancer

 

Something important about surgical treatment of lung cancer.  The best way to treat cancer is not the latest. From the actual effect, surgery is still the most likely method to achieve a complete cure.

Something important about surgical treatment of lung cancer

 


Which lung cancer patients can be operated on

Judging whether a patient with lung cancer can undergo surgery first depends on whether the diagnosis of the disease is clear; secondly, it depends on whether the patient’s physical condition is suitable for surgery.

1. Disease diagnosis depends on pathological results. If there is no pathology, the next treatment will be blind. Pathology can be obtained by puncture or bronchoscopy, but if these methods are not available, then the pathology can only be obtained by surgery to confirm the diagnosis, that is, it is not ruled out that some patients are confirmed to be benign lesions after surgery.

From the perspective of diagnostic staging, generally speaking, early stage (stage I) lung cancer, intermediate stage (stage II-IIIa) lung cancer, and partially selective stage IIIb lung cancer where the tumor is confined to one side of the chest cavity are suitable for surgical treatment, as follows:

(1) Stage I lung cancer;

(2) Stage II-IIIa non-small cell lung cancer;

(3) Part of stage IIIb non-small cell lung cancer that is confined to one side of the chest cavity and can be completely resected;

(4) Patients with stage IIIa and part of stage IIIb lung cancer who are down-staged after preoperative neoadjuvant chemotherapy;

(5) For non-small cell lung cancer with isolated metastasis (that is, intracranial, adrenal or liver), after multidisciplinary consultation, it is confirmed that both the primary tumor and metastatic tumor are suitable for surgical treatment, and there is no contraindication to surgical operation, and Can achieve complete resection of the primary tumor and metastasis;

(6) Diagnosed non-small cell stage IIIb lung cancer, the tumor invades the pericardium, large blood vessels, diaphragm, and tracheal carina. After various examinations, distant or/and micrometastases have been excluded. The disease is limited and the patient has no contraindications for physiological surgery. , Can achieve complete resection of tumor invaded tissues and organs.

2. Judging from the patient’s physical condition, whether to tolerate the operation, firstly determine whether the lung function can tolerate the lung lobe or whole lung surgery, and secondly determine the function of the heart and brain and other important organs. If the patient has a recent cerebrovascular accident or Myocardial infarction is not recommended for immediate surgery. Basic diseases such as diabetes and hypertension generally do not affect the choice of surgery.

 

 

How to choose the surgical method

Surgical resection is the main treatment for lung cancer, and it is also the most important method for clinical cure of lung cancer.


According to the purpose of surgery

According to the purpose of surgery, lung cancer surgery is divided into radical surgery and palliative surgery.

 

Radical surgery refers to the complete removal of the tumor lesions clinically, with clean margins, and systematic lymph node dissection.

Palliative surgery refers to incomplete and incomplete surgery. The purpose of palliative surgery is twofold, one is called reduction, which relieves the patient’s symptoms, such as hemoptysis, fever, and pain. The other is to reduce the tumor burden, to remove the tumor to reduce the size of the tumor, which is conducive to radiotherapy and chemotherapy, and it is hoped that good results can be achieved.

 

According to the scope of surgery

According to the scope of surgery, common surgical methods can be divided into wedge resection, segmentectomy, lobectomy, combined lobectomy, bronchial sleeve lobectomy and pneumonectomy.


According to the specific operation method

According to the specific operation methods, lung cancer surgery is divided into open thoracic surgery and minimally invasive surgery.

The surgical instruments used in traditional open thoracotomy to treat lung cancer are large, thick, and long. The incision is located on the side chest wall and almost spans half of the chest wall. The incision is often more than 25 cm. The surgical incision is long and traumatic; the operation needs to cut off the rib or even remove a section Ribs. During the operation, instruments need to be used to prop up the ribs; the surgical incision suffers from sharp injuries from the scalpel and blunt injuries from the spreader; the hands of the surgeon and its assistant must be inserted into the chest cavity and operated by hand; only the operator’s field of vision Preferably, the tumor is removed under direct vision. The postoperative pain is obvious and painful, and the upper limb function of the postoperative patient may be more or less affected by it. The patient’s recovery is also slower, and the “centipede” scar that exceeds 25 cm after thoracotomy is also a strong psychological shock for the patient.

The emergence of minimally invasive thoracoscopic surgery has brought a vibrant spring to thoracic surgery. Minimally invasive thoracoscopic surgery is to make a few small holes about 1.5cm long in the chest, and then send the camera lens and micro surgical instruments into the chest through the small holes, and it is easy to find the location of the lesion under the TV screen. Compared with traditional open thoracotomy, although minimally invasive surgery has a small opening, it has a wider surgical field of vision: through the flexible camera lens, you can clearly see the places that are not easy and inconvenient for traditional open thoracotomy, and then through the micro Surgical instruments perform surgery on the diseased area and completely remove all diseased tissues to achieve the purpose of radical surgery. Surgical instruments are small, thin, and long. The operation is less traumatic to the patient, the patient’s pain is reduced, the postoperative recovery is faster, and the hospitalization time is long. Shorten, for those who love beauty, the minimally invasive and concealed surgical incision also greatly reduces their ideological burden.

 

What is the prognosis of lung cancer surgery

If it is treated by surgery alone, the long-term prognosis of the patient is not very satisfactory. At present, the comprehensive treatments such as surgery, radiotherapy and chemotherapy are mainly adopted. Generally speaking, we can achieve a cure rate of 70%-80% (five-year survival rate) for stage I lung cancer patients, about 50% for stage II, about 20% to 30% for stage III, and about 20% to 30% for stage IV. Very low, maybe less than 5%.

If the lung cancer recurs, is it impossible to operate again? At this time, the following issues should be considered:

 

The pathological nature and type of the tumor you did for the first time, and the pathological stage at that time, you also need to understand the treatment and the response to the treatment at that time;

The time between the current tumor and the last operation;

The current range of lesions means the recurrence, how much surgery to do, and what is its resectability;

At present, the patient’s physical condition can not tolerate this operation.

 

In addition, it is necessary to comprehensively consider whether the current tumor has other better treatment methods besides surgery, such as radiotherapy or chemotherapy. At the same time, it is necessary to evaluate the benefits that the operation can bring to the patient, that is to say how long his life expectancy can be reached, these issues must be comprehensively evaluated. At present, there are not many patients undergoing secondary operations in clinical practice.

 

Even if there is no opportunity for surgery, it does not mean that the prognosis must be poor. There are many reasons for inoperability. Sometimes the disease itself is very small, but the patient’s physical condition does not allow it. For example, there is a very serious heart problem, poor lung function or other diseases of the body that cannot be operated. In addition, although some lesions are late, they are very sensitive to current drug treatments, such as chemotherapy or targeted therapy, and still get a better prognosis.

 

At the end

Need to remind everyone that the above information is for your reference only. Cancer treatment is a complex system engineering, and everyone’s condition is different. Therefore, please communicate with your doctor in charge for specific treatment and surgical plans.

 

(source:internet, reference only)


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