Large 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 large cell carcinoma of the lung. Common surgical procedures for the treatment of large 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 large cell carcinoma of the lung.^[1]^[2]^[3]
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.

Surgical Options

Common surgical procedures for the treatment of large cell carcinoma of the lung, include: ^[4]

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

Indications

Surgery is usually reserved for patients with large cell carcinoma with the following characteristics:^[5]

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

Large cell carcinoma of the lung surgery is usually contraindicated in patients with the following characteristics: Large 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 large cell carcinoma of the lung surgery, include:^[2]

Nosocomial pneumonia

Prolonged mechanical ventilation

References

↑ Doddoli C, Barlesi F, Chetaille B, Garbe L, Thomas P, Giudicelli R, Fuentes P (April 2004). “Large cell neuroendocrine carcinoma of the lung: an aggressive disease potentially treatable with surgery”. Ann. Thorac. Surg. 77 (4): 1168–72. doi:10.1016/j.athoracsur.2003.09.049. PMID 15063228.
↑ ^2.0 ^2.1 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.
↑ Wertzel H, Grahmann PR, Bansbach S, Lange W, Hasse J, Böhm N (November 1997). “Results after surgery in undifferentiated large cell carcinoma of the lung: the role of neuroendocrine expression”. Eur J Cardiothorac Surg. 12 (5): 698–702. PMID 9458138.
↑ Lung cancer surgery. Wikipedia. https://en.wikipedia.org/wiki/Lung_cancer_surgery Accessed on March 10, 2016
↑ 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.

Template:WikiDoc Sources

[pmid15063228-1] Doddoli C, Barlesi F, Chetaille B, Garbe L, Thomas P, Giudicelli R, Fuentes P (April 2004). “Large cell neuroendocrine carcinoma of the lung: an aggressive disease potentially treatable with surgery”. Ann. Thorac. Surg. 77 (4): 1168–72. doi:10.1016/j.athoracsur.2003.09.049. PMID 15063228.

[pmid16618956-2] 2.0 ^2.1 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.

[pmid9458138-3] Wertzel H, Grahmann PR, Bansbach S, Lange W, Hasse J, Böhm N (November 1997). “Results after surgery in undifferentiated large cell carcinoma of the lung: the role of neuroendocrine expression”. Eur J Cardiothorac Surg. 12 (5): 698–702. PMID 9458138.

[wiki-4] Lung cancer surgery. Wikipedia. https://en.wikipedia.org/wiki/Lung_cancer_surgery Accessed on March 10, 2016

[pmid22054885-5] 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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