Q: The patient is a 55-year-old female with long-standing chronic bronchitis, emphysema, and interstitial pneumonia, with occasional acute attacks of asthma every year, and physical examination reveals a glassy lesion of the right upper lobe membrane (GGO). What should I do? Can I have surgery if my lung function is low? If surgery, what about asthma attack after surgery? Can it be operated? Zhang Jun, Lung Cancer Center, China Medical University A: Lung cancer, if it can be detected early, diagnosed early and treated with early surgery, may be cured. Once lung cancer is diagnosed, those who can be operated should try to take surgical treatment first. Surgery is the only possible cure for lung cancer. The patient is a female, 55 years old, with chronic bronchitis, emphysema, interstitial pneumonia for many years, acute asthma attack at irregular intervals every year, and right upper lobe membranous glassy lesion (GGO) found in physical examination, what should we do? Surgery or not? Most GGOs do not require surgery. However, in this case of GGO, the imaging features suspected lung cancer and surgery was recommended. Although the CT report did not suspect lung cancer or lung space-occupying lesions, or even “consider inflammatory lesions”, “recommend observation”, “recommend anti-inflammatory treatment”, the surgeon, however, had his own, more important, “anti-inflammatory treatment”, and “anti-inflammatory treatment”. But the surgeon has his own, more important, “first-hand” experience. Based on the actual experience of previous GGO surgeries, we recommend surgery for this patient. The patient is slightly fat, with chronic bronchitis, emphysema, interstitial pneumonia, acute asthma attacks every year, and low lung function, which makes the surgery risky; if the post-operative pathology is not lung cancer, and post-operative complications or even life-threatening diseases happen to occur, it will be very regrettable, and both the patient’s family members and the surgeon will be very chagrined and regretful. However, Western medicine believes in science, facts, and evidence; the imaging characteristics of the lesion are also evidence; it is only that it is still temporary, not easy, and not grasped and recognized by most doctors; after comprehensive judgment, it is still believed that: lung cancer is highly probable, and it is recommended that surgery be performed as soon as possible. “Surgery is risky, and can be very risky, likely to trigger an asthma attack or even lead to a life-threatening condition…” ; truthfully informing the patient himself and his family about his condition and the possible risks; “Even if it is a benign lesion, once the surgery is performed, the risks are the same”; “It is indeed a very difficult decision to make”; “The patient and his family, who felt embarrassed “; “The surgeon, why not feel the dilemma”; “In and out are for the good of the patient”; “In! What if we can’t find the lesion intraoperatively, the GGO is both small and thin hard to determine.”.” ; “If the pathology result is really benign lesion, and really complication or even life-threatening happened.”.” ; “But, “Back off! may be giving up a, wonderful opportunity to find early lung cancer and cure early lung cancer”; “Lung cancer, still rarely can be detected early, and even more rarely can be treated by early surgery”; “The patient is also still very young, and in vain to wait for the lung cancer to grow up, and then to decide to to have surgery, it may have metastasized long ago”; “Lung cancer, especially lung adenocarcinoma, is prone to early metastasis; the primary foci are very small and have metastasized; it would be a pity”; “The decision to operate is for the patient’s best interest” ; “But the patient has a life risk, and the doctor has a professional risk”; “The patient, the doctor, are shoulder to shoulder, facing the same enemy”; “The patient has to take the life risk for his own sake; the doctor has to take the patient’s professional risks”; Patients and their families are willing to take the risks to their lives resulting from, and secondary to, surgery. The surgeon is willing to take the professional risk of operating on a dangerous patient. Surgery is performed as scheduled. In order to minimize the trauma and the chance of postoperative complications, it was decided to overcome the difficulties and adopt “minimally invasive small incision, without breaking the muscle, without breaking the ribs, minimally invasive open thoracic surgery”, but the actual difficulties encountered during the operation were far more difficult to deal with than expected. As soon as the chest was opened, the patient was immediately stupefied! — Is small incision surgery possible? “Intraoperatively, we see extensive intrathoracic adhesions and calcifications.” – Is small-incision surgery possible? “Intraoperatively. What else was seen?” “No definite lesions were seen at all….” ;— How else can the small incision surgery go on? “If you can’t find a lesion, it’s a big incision, and even a bigger incision won’t help!” “Silly! You really can’t see a clear lesion!” “Palpate with your fingers! “We can’t even feel the lesion with our finger tips!” “It’s silly! What if we cut off the lobes and can’t find it again?” Tough choices! Tough mentality! Exactly as expected before the operation! The heart, indeed, felt an extremely strong, shockwave! A scientific prediction is just a prediction, it’s not a substitute for the truth. “Do we really have to cut the lobes off?” “What if we can’t find any more lung cancer?” Or even, “What if we can’t find the lesion at all?” “All in the name of God?!” Yellow sky and thick earth! Thank God for that! The surgeon was right! The result of the surgery was just as the surgeon had decided: intraoperative pathology diagnosed “lung cancer”! “Early lung cancer! Adenocarcinoma in situ!” The family’s heart fell to the ground! The doctor’s heart was also “on the ground”! If the patient lying on the operating table could hear the results of the intraoperative pathology diagnosis, the patient’s heart would also be “on the ground”! There’s no need to say anything. The operation was done correctly! Further, the mediastinal lymphatic tissue was cleared for a cure! This is the end of the story! I don’t need to write any more! However, life is like that. What you fear, you will get! After the surgery, the patient woke up soon after the operation! The trauma was indeed minimal! Complete freedom of movement of the upper limbs on the operated side! Totally unimpeded! Totally strenuous! It’s really less traumatic! On the first day after surgery, you can move freely in bed! You can consider getting out of bed! The second day after surgery, basically back to normal, asked to go down to the ground, asked to leave the monitoring room! The third day after surgery. “How does it compare to more than the usual major incision surgery?” “I’ve heard about it, I’ve seen it, and I’ve experienced it for myself, there’s no comparison!” On the fourth postoperative day, the upper chest drain was removed, and on the fifth postoperative day, the lower chest drain was removed, and everything came together too well for this patient’s condition! It seems that all the possible postoperative phlegm, sputum evacuation, lung infection, asthma attack, dyspnea, tracheotomy, and ventilator-assisted respiration that had been anticipated before the surgery were just bluffing themselves! Just when the patient, the family, and even the surgeon, are starting to have to relax and communicate the celebrations of the previous days, “It’s 6 or 7 days post-op and we’re ready to be discharged!” “If it wasn’t for the fact that I had old lung disease in the past, and had asthma, I could have been discharged! It’s just that I’m afraid that after the surgery, “the lungs are in trouble”, and I’d rather stay a few more days!” As the saying goes, what you are afraid of will come! What should come, always come! “I’m ready to leave the hospital and go home in 1 or 2 days!” On the evening of the 7th day after the operation, I don’t know what happened, but I began to experience “panic, shortness of breath, not enough air! I even coughed!” The patient himself knew! The patient himself knew: “It’s bad! He’s having an asthma attack!” “Handle it quickly!” 。。。。。。 The good news is that there was no danger of an asthma attack! “After 4 or 5 days, the condition was under control and completely returned to normal! “Every time I have an attack, it’s always like this”, the patient himself knows more about the process from the onset of the disease to the relief and stabilization: “Incoming and outgoing air, all even and smooth, not so much coughing, and no phlegm, so that is good!” “Now it works again!” “I can leave the hospital!” “Thanks to the small incision! And thanks to the minimally invasive surgery!” “Good and quick recovery!” “The body was mostly recovered before the asthma attack. Both chest drains have been removed!” “This would have been if we still had the two big tubes, and then we would have had to cough, sputum, and wheeze all over again.” “I’m afraid!” Indeed, it is conceivable that if the usual large incision surgery had been performed, the trauma would have been much greater, and the wheezing attack could have been induced very quickly, and could have worsened very quickly, or even induced respiratory failure, requiring assisted breathing, and a ventilator, which would have been much more serious, and even life-threatening, and unimaginable. “I can feel it!” “Minimally invasive radical lung cancer surgery with small incisions, without muscle or rib cage”, “It’s really less invasive”, “It’s really fast and good recovery!” “Both radical and minimally invasive”; “And no extra cost”; “Indeed minimally invasive surgery affordable to the people”; “Indeed the people’s minimally invasive surgery for themselves!”