Lung Cancer Surgery Remains Vital Despite New Treatment Options
Types of Lung Cancer Surgery
There are three main types of lung cancer surgeries: lobectomy, pneumonectomy, and wedge resection. A lobectomy involves removing one complete lobe of the lung, usually done for early-stage non-small cell lung cancer. It is the most common surgery for lung cancer and removes the tumor with some surrounding tissue along with the lymph nodes.
A more extensive surgery is a pneumonectomy, which removes one complete lung. This is done if the cancer is large or involves the main branches of the bronchus. A less extensive surgery is a wedge resection, which removes a small piece of lung around the tumor, leaving the lung structure mostly intact. Wedge resections are usually performed for small peripheral lung tumors.
Factors Considered for Lung Cancer Surgery
Whether a patient qualifies for surgery depends on factors like the Lung Cancer Surgery type and stage, overall health and fitness of the patient, and any other medical conditions. Early-stage NSCLC up to stage IIIA is typically considered for surgery with curative intent provided the patient meets surgical criteria. Advanced stage IIIB and stage IV cancers are usually not surgically removable.
Pre-surgical evaluations involve PET/CT scans, pulmonary function tests, cardiac clearance and sometimes a mediastinoscopy to stage the lymph nodes. Those with reduced lung function due to age, smoking or other lung disease may not be fit for extensive resections like pneumonectomy and require more conservative surgeries.
Role of Minimally Invasive Surgeries
In recent years, the advent of minimally invasive video-assisted thoracoscopic surgery or VATS approaches have enabled performing lobectomies and wedge resections through smaller incisions rather than a large chest incision. VATS offers benefits like less post-operative pain, faster recovery, fewer complications and better cosmetic outcomes. However, it may not always be possible due to tumor size or location.
Adjuvant Therapies After Surgery
While surgery remains the primary treatment for early-stage resectable lung cancers, adjuvant chemotherapy or radiation or both are often recommended afterwards to eliminate any remaining microscopic tumor cells and reduce the risk of recurrence. This is especially important for patients with stage II or III cancers who are at higher risk.
Clinical trial results have shown that platinum-based chemotherapy administered for 4-6 months after surgery can improve survival rates in stage IB-IIIA NSCLC patients. For certain high-risk patients, adjuvant radiation alone or combined chemo-radiation may be advised based on margin status and nodes involvement.
Challenges of Sleeve lobectomy
Despite the benefits, sleeve lobectomy poses unique challenges due to the critical function of lungs. Significant risks of surgery include prolonged air leaks, pneumonia, effects on pulmonary function and cardiac complications. Morbidity and mortality rates can be high for extensive pneumonectomies done for centrally located large tumors.
Another limitation is the ineligibility of a large proportion of lung cancer patients at the time of diagnosis due to advanced stage or co-existing health issues. Less than 25% of all lung cancers are surgically resectable. With the availability of new effective non-surgical treatments, even some early-stage patients may opt for those options due to individual medical circumstances or preferences.
Sleeve lobectomy continues to play an important curative and life-prolonging role in the management of early-stage non-small cell lung cancers when performed by experienced surgical oncologists. Surgical techniques, equipment and precautions are also constantly improving postoperative care and outcomes.
Minimally invasive approaches now allow operating on select patients gently who otherwise may not have tolerated open surgeries. Combined with standardized multi-modality adjuvant treatments, sleeve lobectomy remains an integral component of potentially curative therapies. Developing better selection criteria can expand its benefits to more patients.
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