1. Thoracic Surgery Innovations

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

3. VATS
Sympathectomy
Pleurectomy
Lobectomy
Biopsy
mass
lung

6. Pneumothorax

7. Pleurectomy
VAT
Muscle sparing
Mini
Full Thoracotomy

8. VAT Lobectomy

9. Biopsy Lung / Pleura

11. LVRS

12. LVRS

14. 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

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

17. Chemotherapy and Radiotherapy
Preoperative Neoadjuvant
Operative
Postoperative Adjuvant

18. 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

19. 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

20. 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

21. 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

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

23. 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

26. Small Cell Lung Cancer

27. Small Cell
All need :
Mediasteinoscopy
CT head
Bone scan

28. Pre operative N2
Young patients
Pre op chemo downstage
No evidence

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

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

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

32. Stapler In Oesophagogastrectomy

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

36. SVC Stents

38. Any Questions ?

39. Next Week 2nd March Inotropes ITU seminar room