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Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

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Page 1: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 2: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Surgical treatment of lung cancer. Past and present. Methods Mol Med. 2003;75:453-87. Mountain CF, Hermes KE.

Page 3: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Lung Cancer

Page 4: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 5: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

End Effect

Etiology

Page 6: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 7: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 8: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Pros Cons

Page 9: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Better pretreatment staging including the avoidance of unnecessary surgery in 20% of patients

Page 10: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Mediastinoscopy: invasive staging Endobronchial Ultrasound:

Page 11: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 12: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

1980-1990’s: Modern Era of VATS

Page 13: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 14: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Ann Thorac Surg 2006: 81)

Page 15: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 16: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Potential Advantages of Minimally Invasive Lobectomy

Page 17: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 18: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 19: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 20: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 21: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 22: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 23: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 24: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Intraoperative Imaging “Overlay “ vision

Page 25: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Single Largest Center for Intraoperative Imaging in world

Courtesy of Dr. Sunil Singhal

Page 26: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Prior to surgery

Courtesy of Dr. Sunil Singhal

Page 27: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Goal of the operation:

Challenges:

Courtesy of Dr. Sunil Singhal

Page 28: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Courtesy of Dr. Sunil Singhal

Page 29: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall

Better pretreatment staging including the avoidance of unnecessary surgery in 20% of patients

Page 30: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 31: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 32: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall
Page 33: Surgical treatment of lung cancer. Past and present. Methods€¦ · OF LUNG CANCER 1956 Superior sulcus- Preop. XRT- Shardack & Macallum 1952 lobectomy- Price Thomas 1947 Chest wall