In the past 2 months, I had GGO surgery one after another, all of which were early stage lung cancer.
If early detection, early surgery and early prevention can be achieved, if we can really achieve the “three early stages”, why should we not worry about lung cancer?
I have some sighs.
I have something to say.
Let me tell you one by one.
A few days ago, I consulted a patient with pulmonary vitreous lesion who had been consulted by several hospitals in and outside the province and was recommended for observation.
After reading the films, surgical treatment was recommended and it was a direct lobectomy.
The patient, 68 years old, a provincial hospital doctor, old professor, a daughter working in Beijing, a daughter working in the United States, several siblings in the medical system, a sister is a professor of surgery in a provincial hospital.
I have to talk a lot.
The patient himself, medical peers, experts with certain qualifications.
The patient’s family and family members, medical peers, many of whom are qualified specialists.
As soon as they heard the recommendation to operate as soon as possible, they immediately became a bit furious.
The reaction was a little too much, a little more than I thought.
Immediately, they asked.
Didn’t you say that most GGOs don’t need surgery?
Moreover, other hospitals, including the big ones in Beijing, have consulted with me.
They all said they were not sure, the lesion was not close to the edge, near the center, and near the blood vessels.
The lesion is too small, low density, and not very solid, so it is not easy to find it even after surgery.
Even if the lesion is cut out, it may not be easy to find.
The lesion may not even be found.
It is not too sure to suspect lung cancer, and even radiologists suspect that inflammatory lesions are more likely.
Even PET-CT does not say that lung cancer is suspected, right?
So, the thoracic surgeons in Dalian and Beijing, simply Shunpo, suggested to observe for 3 months or even half a year first, the lesion is not necessarily growing, frankly not very willing to do surgery, not to cut off a whole lobe of good, good lung lobe, not to mention the patient himself is an old doctor, old professor.
On what evidence do you let the surgery? And as soon as possible? And to lobectomize the lung directly? Can you be sure it’s lung cancer?
The question hits the nail on the head.
Since the lesion is not located in the peripheral part of the lung, it is difficult to remove it locally. In fact, the lesion is so small and low density that it is estimated to be difficult to find during surgery, thus the exact lesion can be found only after surgical lobectomy. Direct lobectomy is recommended.
The basis of the recommendation for surgery is indeed not “evidence-based”.
The reason is simple: the lesion may be early cancerous, or early lung cancer, and it is difficult to find objective evidence.
The recommendation for surgery is based solely on the experience of reviewing the films and on the experience of surgery.
It is entirely correct that most GGO do not require surgical treatment. In this case, the recommendation for surgery was based on experience. It is not “evidence based”.
The decision was left to the patient and family.
The patient himself was initially reluctant to have surgery right away, preferring observation.
But the family, the family members, were adamant that they wanted to trust the surgeon’s judgment and operate to remove it.
Obviously this is a situation where the surgeon is taking a great deal of professional risk.
The probability of the surgeon’s determination being correct is obviously small. The relative risk induced by the surgery is obviously high.
If this were cut out and it were a benign lesion, there would be no complaints; there would be no gossip.
If this is cut down and it is a benign lesion, there will be complications.
If you cut down a benign lesion, you will be left on the stage.
Have you ever thought about the more serious ones?
If the lesion is cut down and not found, how can it be?
If you can’t find the lesion after the incision, you’ll be left on the table. What’s the big deal?
What a coincidence that it happened?
In medicine, don’t believe in evil.
The more you are afraid of problems, the more problems there are.
The more you know a patient, the more you care for a patient, the more you’ll be treated, the more you’ll be drugged.
In a sense, only God can bless.
Good intentions can not replace reality, the morbidity rate is objective and does not depend on human will, no one can guarantee that no complications will occur.
No one can guarantee that no complications will occur, but we can only make continuous efforts to reduce and reduce again, to detect and treat early, and to nip complications in the bud.
We can only make continuous efforts to reduce and reduce again, to detect and treat complications early, to nip them in the bud.
To minimize the damage, reduce the harm, and reduce the risk of life
The surgery has proven to be the right thing to do.
Minimally invasive small incision surgery with mediastinal lymph node dissection was performed.
Postoperatively, the lesion was confirmed to be located in the lung parenchyma of the middle part of the upper lobe of the left lung, about 0.6X0.5X0.3 CM3, which appeared to be non-existent, and was confirmed to be a small lesion by dissection. Postoperative pathology confirmed that it was a lung cancer, very early stage. The chance of cure was significantly increased.
The good thing is that the minimally invasive surgery is less invasive and the patient recovered smoothly, quickly and well.
There were no complications and the patient was discharged from the hospital cured.
The recommendation for surgery was fully justified. It was based on experience.
The experience of reading the films, the experience of surgery, and the experience of re-reading the films after surgery is valuable and reliable. Direct source with clinical practice. The real valuable experience with this GGO lesion is stronger than PET-CT.