Chest
Current Status of Surgical Resection for Lung Cancer
Section snippets
Indications for Surgical Resection
It is again emphasized that surgical resection is only indicated in patients at acceptable operative risk, in whom the possibility of a complete resection is anticipated. Although two recently reported randomized trials of adjuvant chemotherapy3,4 report promising results in small numbers of patients, most surgeons still take the position that adjuvant treatment should be reserved for patients entered in trials for all stages of resectable lung cancer.
The state of the art in surgery at the
LIMITED RESECTION
The standard resections for primary lung cancer are pneumonectomy and lobectomy. Lesser, or limited operations include wedge resection, segmental resection, nonanatomic limited resection, and sleeve lobectomy. Initially, all of these lesser resections were employed as compromise operations in patients with poor pulmonary reserve who would not tolerate a traditional lobectomy or pneumonectomy. Tumors amenable to wedge resection or segmental resection are almost always in the T1 stage and are
EXTENDED RESECTION
Locally advanced lung cancer (stages IIIA and IIIB) has a much less favorable prognosis than earlier stages. Nevertheless, in patients with locally advanced tumors which are completely resected, some worthwhile survival is achieved. More importantly, there is no alternative form of treatment which will provide comparable results.
The role of adjuvant therapy in the management of locally advanced, resectable lung cancer has been evaluated in many phase II and phase III trials. Chemotherapy and
SMALL CELL LUNG CANCER
There is a small number of patients who present with locally resectable N0 tumors. Survival in these patients is similar to that reported for non-small cell primaries. Unfortunately, this group represents a very small segment of the population presenting with small cell tumors. There is no reported evidence that these patients benefit from the addition of adjuvant chemotherapy, though many oncologists will recommend combined treatment even for a completely resected T1N0 neoplasm.30
Accepted
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Survival of patients with or without symptoms undergoing potentially curative resections for primary lung cancer
2013, Annals of Thoracic SurgeryVariation in surgical resection for lung cancer in relation to survival: Population-based study in England 2004-2006
2012, European Journal of CancerCitation Excerpt :Non-small cell lung cancer (NSCLC) comprises over 85% of all lung cancers. In patients with early stage NSCLC, pulmonary resection provides the best form of potentially curative treatment.4 The resection rate in England is reportedly around 10%,5 whereas elsewhere in Europe and the US resection rates of around 20% to 30% are reported.6–8
The role of positron emission tomography for non-small cell lung cancer
2011, Practical Radiation OncologyCitation Excerpt :Studies using a percentage of the maximum SUV as a threshold for auto contouring the tumor have suggested values ranging from 15% to 50%. In a study utilizing phantoms containing known FDG volumes ranging from 0.4 to 5.5 cm3, a threshold of 36% to 44% was suggested depending on the source to background ratio. A multiple threshold method based on tumor size has been suggested to be more appropriate.
Long-Term Quality of Life After Lung Resection
2008, Thoracic Surgery Clinics