Advance in Lung Cancer Surgery

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    Advance in Lung Cancer Management:

    Surgeon’s View

    Punnarerk Thongcharoen, MD

    Division of Cardio-thoracic Surgery Department of Surgery

    Faculty of Medicine Siriraj ospital

    Mahidol !niversity, Thailand

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    • Lung cancer

     incidence/100000

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    Lets fght against lung

    cancer• Reduce revalence o! lung cancer

    • "mrove treatment outcome o! lung

    cancer

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    Lung cancer treatment

    e#uation• $arl% case & Relativel% good outcome

    • $arl% case & Surger% is a mainsta% o!

    treatment •  'hus

    • Surger% is a (e% to good outcome)

    • And* o! course*

    • A surgeon is a (e% to good outcome+

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     'o imrove outcome o!

    lung cancer treatment

    •  'o increase the num,er o! surgicall%

    curative candidate

    •  'o ma-imi.e the survival a!ter surger%

    and minimi.e the mor,idit% and mortalit

    % during erioerative eriod

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     'o increase the num,er o!

    surgicall% curative candidate

    • etect more earl% case among general/ high

    cancer ris( oulation  lung cancer screening 

    • iagnose lung cancer among atient resenting

    with ulmonar% lesion that might ,e cancer

    S2* mass3)4 more e5ectivel%

    • irect those surgical candidates to thoracic

    surgical service as much as ossi,le and ASA

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     'o ma-imi.e the goods and

    minimi.e the ,ads

    • evelo surgical techni#ue that

    rovide the ,est oncologic outcome

    • 2eoad6uvant/ ad6uvant thera%*

    integrated holistic care

    • Minimall% invasive era

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    Lung cancer screening

    • Recommend onl% !or high cancer ris(

    oulation

    • Low dose C' chest

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    7ow to 33 e5ectivel% diagnose lung

    cancer in atient resenting with ul

    monar% lesion that might ,e cancer

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     'issue diagnosis is the (e%+

    • Lung cancer is still ossi,le8*  

    tissue diagnosis confrmed that it is d

    efnitel% CA2C$R or 29' cancer

    • $-cision ,ios% is the last answer)

    • 2o more 'R"AL and error4 with anti

    t,c regimen

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    Recommend

    • Chest s%mtom  ;wee(

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    atient with ulm nodule/

    mass• Review revious imaging stud%  –Most lung cancer are not

    >etting ,igger within less than amonth

    • Sta,le !or more than  %ears

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     'in% solid nodule ? @ mm4

    'i , lid d l  @

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    • revalence o! malignanc% is higher)

    • Recommended /= C' duration is

    shorter

     'in% su,solid nodule ? @

    mm4

     l d l

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    ulmonar% nodule:

    aroach• irst* start with estimate the

    ro,a,ilit% o! malignanc% ,%  –

    clinical 6udgment and/or  – a validated model Ma%o 3 most

    oular4

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    Solid nodule

    • Second* customi.e diagnosis

    aroach ,% si.e and retest li(eliho

    od

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    Solitar% ulmonar% nodule

    • $' availa,le  – Ver% low  C' surveillance

     – Low to mod li(elihood  $'

     – 7igh  Bios% S-/ nonS-4

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    Solitar% ulmonar% nodule

    • $' ; 29' availa,le  – Ver% low  C' surveillance

     – Low to mod* high li(elihood  Bios%

    S-/ nonS-4

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    Surgical role in - aroach

    • rimar% lesion  – edge resection : 9en/ VA'S

    • Mediastinal L2  – Cervical mediastinosco%* anterior

    mediastinotom%* VA'S

    • leural metastasis  – VA'S

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    ulmonar% nodule:

    2on S- vs S- B- • hen clinical ro,a,ilit% and imaging are discordant

    • Benign - re#uiring secifc medical R- is susected

    Susect cancer with mediastinal invasion or distant metastasis/ SCLC

    • 7igh retest ro,a,ilit%

    • Non Sx Bx result is non diagnostic and

    suspicioun of malignancy remains 

    • $' strongl% ositive

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    Mediastinal B-

    • irst choice is now $B=S

    • Cervical mediastinosco% : indication  –

    $B=S: susicious  – Re;assessment ost induction CM';R'

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    Surgical role in staging

    • 2 disease: 'he line ,etween earl%

    and advanced* good outcome and o

    or outcome)

    • "nvasive mediastinal staging is ver%

    imortant)

    • $-tensive mediastinal invasion on C'

     no !urther invasive staging

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    Video;mediastinosco%

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    iagnosed earl% lung cancer

    •  'he most e5ective treatment should include

    surgical resection as a mainsta% o! treatment)

    •  'he rimar% concern !or B-;confrmed earl% 2SCLC

    is ro,a,l% how to get the atient to the 9R)

    •  'he surger% re!usals seem to ,e a considera,le

    reserve in onconeumonolog% to raise the oera,ilit

    % o! lung cancer and to imrove the results o! its sur

    gical treatment)

    ! ili i h h ! 8

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    Are %ou !amiliar with these !acts8

    Factors related with decision

     Yes (%

    refuse)

    No (%

    refuse)

    P

    "ge # $% &' %' ()(*

    +elief that D is  .(/ certain

    &0 %* ()(( 0

    +elieve eposure to air

    during surgery spreads cancer

    &$ %( ()( (*

    Faith alone cures disease

    &1 %( ()( (*

    Pra er 2ill cure cancer &% %' ()((

    Reasons 29' a5ected

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    Reasons 29' a5ected

    re!usal to S-Issues Yes (%

    refuse)

    No

    (%

    refuse)

     p

    3ducation  *% years %1 %4 5S +iopsy-con6rmed %1 %4 5S

    Physician discusses pros and cons of S

    %4 &( 5S

    Family must approve S &% %& 5S

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    Lets do some e-ercise

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    Scenario

    • An as%mtomatic woman* DE %ears old*

    chec(ed u at a 7osital A)

    • Chest -;ra% showed a ))cm S2 at RLL)

    • C' showed irregular nodule susected

    CA with !ew aratracheal L2 0)E;0)@ cm

    • $'/C' was done

     

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