Squamous cell carcinoma of the lung surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Surgery is the mainstay of treatment for squamous cell carcinoma of the lung. Common surgical procedures for the treatment of squamous cell carcinoma of the lung include pulmonary lobectomy, pneumonectomy, lung resection with lobectomy, lung resection with pneumonectomy with or without lymph node dissection. The preferred surgical procedure is thoracotomy with removal of the entire lung or lobe (lobectomy) along with regional lymph nodes and contiguous structures. Common complications of squamous cell carcinoma of the lung surgery include atelectasis, nosocomial pneumonia, prolonged mechanical ventilation, respiratory failure, bronchospasm, pulmonary embolism.

Surgery

Surgery is the mainstay of treatment for squamous cell carcinoma of the lung^[1]
Common surgical procedures for the treatment of squamous cell carcinoma of the lung, include:

Pulmonary lobectomy
Pneumonectomy
Lung resection with lobectomy
Lung resection with pneumonectomy with or without lymph node dissection

The feasibility of surgery depends on the stage of squamous cell carcinoma of the lung at diagnosis
Surgical intervention is not recommended for the management of metastatic squamous cell carcinoma of the lung

Indications

Squamous cell carcinoma of the lung is usually reserved for patients with the following characteristics:^[2]

Pulmonary function testing

Preoperative assessment of FEV1/DLCO
FEV1 >2 L (or more than 80%)
DLCO > 80

Exercise testing

Successful cutoff of 22 m on the stair climbing test

Fitness for surgery

Evaluation of risk factors, such as:
Age
General health status (obesity, Karnofsky scale >70)
Chronic obstructive pulmonary disease
Asthma
Smoking
Other conditions: pulmonary hypertension, heart failure, and metabolic factors

Contraindications

Squamous cell carcinoma of the lung surgery is usually contraindicated in patients with the following characteristics:

Squamous cell carcinoma of the lung extension past the diaphragm

Extrathoracic metastases
Metastases to supraclavicular lymph nodes
Contralateral mediastinal node metastases

Involvement of contralateral hemithorax
Invasion to structures of the mediastinum

Involvement of the main pulmonary artery

No fitness for surgery
Hypercapnia (arterial PCO2 greater than 45 mmHg)
Inadequate exercise testing results (22 m on the stair climbing test)
Presence of oncological emergency, such as: superior vena cava syndrome, malignant pleural effusion, cardiac tamponade, vocal cord or phrenic nerve paralysis

Complications

Common complications of squamous cell carcinoma of the lung surgery, include:^[1]

Atelectasis
Infections

Nosocomial pneumonia

Prolonged mechanical ventilation

References

↑ ^1.0 ^1.1 Smetana GW, Lawrence VA, Cornell JE (2006). “Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians”. Ann. Intern. Med. 144 (8): 581–95. PMID 16618956.
↑ von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT (2011). “Functional evaluation before lung resection”. Clin. Chest Med. 32 (4): 773–82. doi:10.1016/j.ccm.2011.08.001. PMID 22054885.

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[pmid16618956-1] 1.0 ^1.1 Smetana GW, Lawrence VA, Cornell JE (2006). “Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians”. Ann. Intern. Med. 144 (8): 581–95. PMID 16618956.

[pmid22054885-2] von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT (2011). “Functional evaluation before lung resection”. Clin. Chest Med. 32 (4): 773–82. doi:10.1016/j.ccm.2011.08.001. PMID 22054885.

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