Surgical Resection of Lung Tumors 肺部腫瘤切除手術說明(英文)
Surgical Resection of Lung Tumors 肺部腫瘤切除手術說明(英文)
Reason for Surgery
- Where the patient's lung tumors are diagnosed as malignant lung tumors by sputum cytology, fiberoptic endoscopy, thoracic ultrasound puncture and computed tomography, complete or partial lobectomy combined with mediastinal lymph node clearance is recommended in order to obtain the best chance of curing the disease.
- The imaging examination of the chest shows that there is a suspected pulmonary lobe tumor, so a surgical biopsy is recommended, and appropriate surgical or drug treatment steps should be taken after the correct pathological diagnosis to fundamentally treat the disease.
Physical Evaluation before Surgery
- A detailed general scan of the tumor reveals no evidence of metastasis in any other organs except the chest.
- The physiological functions of the patient's main organs, including lung, heart, liver and kidney functions, are all within the acceptable range of anesthesia and operation.
- A comprehensive examination of the patient's pulmonary function shows that the expected residual pulmonary function after surgical resection is within an acceptable range (FEV1>0.8-1.0L).
Steps and Scope of Surgery
- The operation is performed under general anesthesia and excision is carried out when unilateral lung breathing is controlled under a special double-tube endotracheal tube.
- The thoracoscopic surgery should be performed with 2 to 3 incisions less than 1 cm on the ipsilateral side of the chest wall.
- The human lung lobes are two on the left and three on the right, and are connected by the arteries, veins, and bronchi.
- Radical resection of lung tumors includes lobectomy and lymphadenectomy in the ipsilateral mediastinum.
- After lobectomy, a drainage tube must be inserted into the pleural cavity for aspiration, which will facilitate the discharge of excess thin blood and air.
Expected Surgery Success Rates and Risks
- According to literature records and recent reports, although lung tumor resection is a major surgery, the risk before and after surgery has been greatly reduced due to the improvement of anesthesia technology and postoperative intensive care. Excluding concomitant underlying systemic diseases such as hypertension, diabetes, coronary artery disease, or other organ failure, the mortality rate after resection of lung tumors is generally less than 5%.
- In general, the treatment effect of lung cancer patients is still better when the tumor can be completely resected. The five-year survival rate after surgery is related to the early and late stages of the disease. If it is stage I of non-small cell lung cancer, the five-year survival rate after surgery is more than 80%.
Possible Symptoms Expected after Surgery
- After surgery, depending on the patient's recovery, he/she is usually transferred to the general thoracic surgery ward to facilitate the smooth recovery of respiratory function.
- After the operation, a few patients may temporarily usemechanical ventilation in intensive care units to help smooth expansion of the resected pulmonary lobes and prevent comorbidities such as sputum obstruction, fever and pneumonia caused by lung collapse. During which, the patient is not fit to speak for the time being and must receive treatment at ease.
- Respiratory rehabilitation after surgery is very important. In addition to proper pain control, steam inhalation to reduce phlegm, repeated slapping of the back to remove phlegm, and continuous deep breathing exercises, the cooperation from patients, family members and all medical staff is the best guarantee for smooth postoperative recovery.
Possible Complications, Risks and Management
- Postoperative complications and risks are linked to the scope of surgical resection. For example, the risk of pneumonectomy is theoretically higher by about 10% than that of lobectomy alone.
- Because the blood supply to the lungs comes directly from the right ventricle and pulmonary artery, the location, size, age and previous history of tumor growth are used to evaluate postoperative complications. Arrhythmias, pulmonary edema, or excessive bleeding may occur in a few cases where blood transfusion is required.
- Respiratory rehabilitation after the operation is very important, especially for heavy smokers, the elderly with emphysema, those with poor nutrition and difficulty breathing, and those who suffer from sputum obstruction due to intolerable wound pain. As a result, they may need to receive ventilator support treatment in the intensive care unit due to insufficient alveolar ventilation leading to lung collapse, bronchial obstruction, fever, pneumonia and even respiratory failure.
- A few patients need an extended period of time for thoracic drainage after operation, and may have empyema, pneumothorax, subcutaneous emphysema and respiratory failure, and need further treatment.
- Complications such as wound infection, aspiration pneumonia, pressure ulcer, upper gastrointestinal bleeding and septicaemia may occur in a few patients with different health conditions before surgery and operations received.
- Very few patients are reported to have other complications such as stroke, heart failure, pulmonary edema or myocardial infarction during general anesthesia surgery because of their older age or vascular sclerosis, arrhythmia.
Possible Consequences if Surgery is not Performed
- Lung cancer is a highly malignant tumor, which is prone to metastasis, local invasion and recurrence at the early stage. Surgical removal is recommended as early as possible to eradicate the disease.
- When lung cancer is associated with distal metastasis, the possible clinical discomfort varies with the organs involved, including pain from skeletal metastasis, liver failure and swelling from liver metastasis, pulmonary interstitial edema from lymphatic metastasis, conscious state of brain metastasis or limb paralysis similar to cerebral apoplexy.
- If lung cancer is not actively treated, in addition to the possibility of distal metastasis, local invasion of the tumor itself can also cause necrosis, suppuration, hydrops, hemorrhage, pain, fever and dyspnea.
Alternatives to Surgery
- For a small number of radiographic atypical lesions, interval tracing can be considered, but the appropriateness of tracing should still be determined after discussion with a thoracic surgeon.
- Under the medical considerations of oncology, if the patient decides not to undergo surgical resection, or if the physical function and tumor condition are no longer suitable for surgical treatment, it is advised to choose chemotherapy, cobalt 60 therapy or combination of the above according to the individual condition of the patient.
- According to the current statistics, first-line chemotherapy has a tumor shrinkage response rate of about 15-35%, and can significantly reduce the patients' cancer comorbidities and improve the quality of life.