Episode Details

Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we sit down with Thoracic Surgeon, Dr. Jane Yanagawa to discuss surgical considerations in treatment of NSCLC.

* How do you choose what type of surgical resection to do?

- Considerations:

--Lung anatomy

--Location of the nodule within lung

--Lymph node involvement

-Options:

--Pneumonectomy: removal of whole lung

--Lobectomy: remove a whole lobe

--Segmentectomy/sublobar resection: part of a lobe

* What does “adequate margins” mean? And how do you know if it’s enough?

- If you’re removing the whole lobe, it does not matter as much

- If you’re doing a segmentectomy, you want to have samples evaluated while in the OR because if there is signs of more disease that initially thought, you would take this one step further and do a lobectomy.

- Need to consider the patient’s situation - how good is their status

* Why does preoperative workup matter?

- Pulmonary function tests: Surgeons are looking at the %FEV1 and %DLCO to then predict what their function would be AFTER surgery. After surgery, they want to ensure patient has %FEV1 or %DLCO >40%.

- Lung anatomy: In patients with COPD and endobronchial lesions, sometimes they also get V/Q scans to evaluate ratio

- Cardiac echo: Important in pneumonectomy where removal of lung tissue will also remove a significant amount of blood vessels. Want to rule out pulmonary hypertension pre-operatively.

- Pulmonary hypertension can also affect someone’s survival while they’re ventilating with only one lung during the procedure (“single lung ventilation”).

- Smoking status: Smoking can increase complications by ~60%.

- Pre-habilitation: Encouraging patients to be fit prior to surgery with walking, nutrition, +/- pulmonary rehabilitation

* What is “VATS”?

- VATS stands for video-assisted thoracoscopic surgery; it is not, in itself, a procedure. But a VATS allows for minimally invasive surgery through the use of a camera.

- It involves three incisions (axilla, lowest part of mid-axillary line, one posterior)

* In what scenario is a mediastinoscopy warranted?

- Needed after EBUS if there is still high index of suspicion for cancer involvement in lymph nodes, even if lymph nodes are negative from EBUS

* What is “systematic lymph node sampling”?

- An organized way to sample lymph nodes, including all lymph nodes that are along the way, not just the ones that may be involved

* As a surgeon, how do you determine if a patient is okay for surgery if the mass is invading another structure?

- Ne