I. Indications for lung cancer surgical treatment
Those with the following conditions can generally be selected for surgical treatment of lung cancer.
1. No distant metastasis (M0), including parenchymal organs, such as liver, brain, adrenal glands, bones, extra-thoracic lymph nodes, etc.
2. Those whose cancer tissues have not spread to adjacent organs or tissues in the chest, such as aorta, superior vena cava, esophagus and cancerous pleural fluid, etc.
3.No paralysis of the recurrent laryngeal nerve or phrenic nerve.
4.No severe cardiopulmonary hypoplasia or recent angina attack.
5.No serious liver and kidney diseases and severe diabetes.
The names and meanings of palliative resection and radical resection for lung cancer surgery
1.Radical resection (R)
Radical resection means complete removal of the primary cancer and its metastatic lymph nodes.
Radical resection of lung cancer not only requires the operator to achieve radical treatment under the naked eye, but also requires complete removal of lymph nodes and no residual cancer cells in the bronchial stump under the microscope.
2.Palliative resection (P)
Where there is still residual cancer (pathologically histologically confirmed) in the chest cavity at the time of surgical resection of lung cancer, or where the resection is considered complete at the time of surgery, such as the bronchial stump is normal under the naked eye but there are residual cancer cells under the microscope, it is called palliative resection.
III. Selection of surgical treatment for lung cancer
For stage 0, I, II and III lung cancer cases, lung cancer surgery can be used if there are no contraindications to surgery.
The principles of lung cancer surgical resection are
Complete removal of the primary foci and lymph nodes with potential metastasis in the chest cavity, and preservation of normal lung tissues as much as possible, and total lung resection should be done with caution.
There are several ways of lung cancer surgical resection as follows
1.Local resection
It refers to wedge resection and lung segment resection, that is, local resection can be considered for primary cancer with small volume, poor lung function in old age and frailty, or well differentiated cancer with low malignancy.
2.Lobectomy
For isolated peripheral type lung cancer confined to one lobe without obvious lymph node enlargement, lobectomy is feasible. If the cancer involves two lobes or middle bronchi, upper and middle lobes or lower and middle lobes can be resected.
3.Sleeve lobectomy and cuneiform sleeve lobectomy
If the tumor is located in the lobar bronchus and involves the opening of the lobar bronchus, sleeve lobectomy is feasible; if the opening of the lobar bronchus is not involved, wedge shaped sleeve lobectomy is feasible.
4, total pneumonectomy (generally try not to do right total pneumonectomy)
Where the lesion is extensive and the lesion cannot be removed by the above methods, total pneumonectomy can be carefully considered.
5.Rominopulmonary resection and reconstruction
When the lung tumor exceeds the main bronchus and involves the ridge or the lateral wall of the trachea but does not exceed 2 cm.
(i) reconstruction of the ridge or sleeve total pneumonectomy may be performed.
② If one lobe of the lung is still preserved, we will try to preserve it, and the operation style can be determined according to the situation at that time.