Thoracic Surgery Innovations

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Presentation transcript:

Thoracic Surgery Innovations

Innovations VATS LVRS Chemotherapy Radiotherapy PET Small Cell N2 Stents & Lasers Stapler In Oesophagogastrectomy Epidural SVC stents

VATS Sympathectomy Pleurectomy Lobectomy Biopsy mass lung

Pneumothorax

Pleurectomy VAT Muscle sparing Mini Full Thoracotomy

VAT Lobectomy

Biopsy Lung / Pleura

LVRS

LVRS

LVRS Criteria Dyspnoeic on daily activities Age < 75 No bullae > 5cm Generalised emphysema with regional heterogeneity TLC > 125% FEV1 < 30 % PaCO2 < 50 mmHg, PaO2 > 40 mmHg on air No CAD or Pulmonary hypertension Steroid < 15 mg/day

LVRS Unilateral / Bilateral Thoracotomy / Sternotomy / VAT Role of Physio

Chemotherapy and Radiotherapy Preoperative Neoadjuvant Operative Postoperative Adjuvant

Chemotherapy Numerous agents Adjuvant Neoadjuvant Stage IIIA (N2) Stage II (T2N0) ? Role in N2 disease All oat cell Neoadjuvant Stage IIIA (N2) If respond are resected No residual tumour at surgery means prolonged survival Experimental

Radiotherapy External beam external rays Single / multiple beam / Fraction No Brachy local ie intra bronchial Interstitial directly into tumour Intra cavity in bronchus Adjuvant Postoperative Neoadjuvant Preoperative

Radiotherapy Primary treatment Adjuvant for N1 / N2 Stage 1 and 2 Refuse or unfit for surgery Failure 30 % stage 1 (T1N0), 70% stage 2 (T2N0) 5 year survival 5 to 40% Adjuvant for N1 / N2 Reduces rate local recurrence Survival unchanged ? Role in +Ve resection margins

Radiotherapy Neoadjuvant Palliative Brachytherapy T3 Pancoast prior to surgery Palliative Symptomatic relief Pain, haemoptysis, bronchial, SVC obstruction Bone met pain Brachytherapy Local application high local dose

Chemotherapy and Radiotherapy Adjuvant Neoadjuvant Sequential / concurrent / alternating Good performance status Not standard practice May increase risk surgery

PET 2-(fluorine-18) fluo-2-deoxy-D-glucose (18-FDG) 18-FDG competes with glucose for facilitated transport into tumour cells and also competes with glucose for phosphorylation by hexokinase Positive and negative predictive power

Small Cell Lung Cancer

Small Cell All need : Mediasteinoscopy CT head Bone scan

Pre operative N2 Young patients Pre op chemo downstage No evidence

Stents & Lasers Malignant terminal conditions that are inoperable Benign inoperable conditions

Tracheal obstruction-malignant - Pre and post Nd:Yag laser

Left main bronchus extensive squamous cell carcinoma Metal stent in left main

Stapler In Oesophagogastrectomy

Epidural Pain Poor PFTs Cardiac history Contraindications Low risk On anticoagulants Consent Anatomical Infective

SVC Stents

Any Questions ?

Next Week 2nd March Inotropes ITU seminar room