1. Thoracic surgery Thoracic Surgery Department Regional Hospital for Lung Diseases Szczecin Zdunowo, Poland

2. Long time ago

3. Much later

4. Main carcinogenic factors Chemicals Chemicals –Asbestos –Benzidine –methyl eter –Vinyl chloride –Aromatic hydrocarbons CIGARETTE SMOKING Occupational exposure Occupational exposure –Coal gasification –Hematite and uranium mining –Contact with arsene, nickel, beryl, chrome

5. So called early lung cancer symptoms Cough Cough Hemoptysis Hemoptysis Intrathoracic pain Intrathoracic pain Recurrent pneumonias Recurrent pneumonias Are those symptoms really early?

6. Paraneoplasmatic symptoms Cushing syndrome Cushing syndrome Hipercalcemia Hipercalcemia Gynaecomastia Gynaecomastia Polymyosistis Polymyosistis Peripheral neuropathy Peripheral neuropathy Myasthenia Myasthenia Proliferatic osteoarthropathy Proliferatic osteoarthropathy Lupus erythematosus Lupus erythematosus Acanthosis nigricans Acanthosis nigricans Anaemia, leucopenia Anaemia, leucopenia Thrombocytopaenia Thrombocytopaenia Thrombophlebitis migrans Thrombophlebitis migrans Aseptic endocarditis Aseptic endocarditis

7. Histology

8. Diagnosis Radiology: X-ray, CT, NMR, USG, scintigraphy Radiology: X-ray, CT, NMR, USG, scintigraphy Pathology: sputum cytology, endoscopy, FNAB mediastinoscopy, VATS, explorative thoracotomy Pathology: sputum cytology, endoscopy, FNAB mediastinoscopy, VATS, explorative thoracotomy Genetics: p53, k-ras, CEA, cyfra 21-1, myc Genetics: p53, k-ras, CEA, cyfra 21-1, myc

11. Contraindications for surgery Dissemination Dissemination Horner`s syndrome Horner`s syndrome Vena cava syndrome Vena cava syndrome Vocal cord paresis Vocal cord paresis Pancoast syndrome Pancoast syndrome WHO>2 WHO>2

12. Surgical approach Antero- and anterolateral Antero- and anterolateral Posterolateral Posterolateral Sternotomy Sternotomy Clamshell Clamshell Paulson Paulson Mixed Mixed

13. Anterior thoracotomy

14. Posterolateral thoracotomy

15. Sternotomy

16. Clamshell

17. Paulson

18. Mixed

19. Types of surgery Pneumonectomy Pneumonectomy Lobectomy (incl. sleeve) Lobectomy (incl. sleeve) Segmentectomy Segmentectomy Wedge or marginal resection Wedge or marginal resection VATS VATS

24. Long term survival rates IIIIII 40 - 80% 100%-Japan? 12 - 54% 4 – 33%

25. Combined treatment

26. Pneumothorax Close Close Open Open Tension Tension

28. Treatment Bed rest Bed rest Drainage Drainage Pleurectomy Pleurectomy

29. Drainage