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