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Thoracic Surgery Innovations

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Presentation on theme: "Thoracic Surgery Innovations"— Presentation transcript:

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





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

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