lung cancer: an overview & discussion of minimally invasive surgical therapy
DESCRIPTION
Presentation of "Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy," by Dr. Conrad Vial, Director of Cardiothoracic Surgery, Mills-Peninsula Health Services.TRANSCRIPT
Lung Cancer:Lung Cancer:an overview & discussion of an overview & discussion of
minimally invasive surgical therapyminimally invasive surgical therapy
Conrad Massimo Vial, MD
Director of Cardiothoracic SurgeryMills Peninsula Health System
Tumor
T1 T2 T3 T4
Nodes
N0
N1
N2
N3
IA IB IIB IIIB
IIIB IIIB IIIB IIIB
IIIA IIIA IIIA IIIB
IIA IIB IIIA IIIB
Stage IV = M1Stage IIIB and IV generally unresectable
Lung Cancer
5-yr survival for treated NSCLC according to
surg-path state:
Stage I: ≈ 70%
Stage II: ≈ 50%
Stage III: ≈ 20%
Minimally Invasive Lung Minimally Invasive Lung Cancer OperationsCancer Operations
Video Assisted Thoracoscopic (VATS) Video Assisted Thoracoscopic (VATS) LobectomyLobectomy
& & Lung Sparing OperationsLung Sparing Operations
The Traditional ApproachOpen Thoracotomy
Video Assisted Thoracoscopy (VATS)
VATS Lobectomy
Results in the Literature
• Advantages of VATS Approach . . .Advantages of VATS Approach . . .– Less postoperative painLess postoperative pain– Shorter length of stayShorter length of stay
•Reduced air leaks/length of chest tube Reduced air leaks/length of chest tube placementplacement
•Reduced overall hospital costReduced overall hospital cost
– Faster recovery/return to normal activitiesFaster recovery/return to normal activities– Better postoperative pulmonary functionBetter postoperative pulmonary function– More likely to complete postoperative More likely to complete postoperative
chemotherapychemotherapy
Literature Summary
• VATS lobectomy offers advantages VATS lobectomy offers advantages over conventional thoracotomy over conventional thoracotomy without compromise of short term or without compromise of short term or long term outcomelong term outcome
• VATS lobectomy can become a cost VATS lobectomy can become a cost effective alternative to open effective alternative to open lobectomy in the treatment of lobectomy in the treatment of operable NSCLCoperable NSCLC
Lung Sparing OperationsLung Sparing Operations
Bronchoplasties & Sleeve ResectionsBronchoplasties & Sleeve Resections
Definition of Bronchoplastic Techniques
Sleeve Sleeve LobectomyLobectomy
vsvs
Bronchial Sleeve Bronchial Sleeve ResectionResection
AA
Results in the LiteratureResults in the Literature
• 30 day mortality for all bronchoplastic 30 day mortality for all bronchoplastic procedures is 8%procedures is 8%
• Mortality for sleeve lobectomy is 5%Mortality for sleeve lobectomy is 5%• Mortality for sleeve pneumonectomy is Mortality for sleeve pneumonectomy is
20 – 25%20 – 25%• Mortality rates double or triple in the Mortality rates double or triple in the
presence of;presence of;– Poor pulmonary function (FEVPoor pulmonary function (FEV11< 50% < 50%
predicted)predicted)– Pulmonary hypertensionPulmonary hypertension– Severe coronary artery diseaseSevere coronary artery disease
What are we doing?What are we doing?What are our results?What are our results?
Conrad M Vial, MDConrad M Vial, MDTomomi Oka, MDTomomi Oka, MD
Program in CT Surgery Program in CT Surgery Overall Volume & Outcomes 2008-Overall Volume & Outcomes 2008-
20102010
TOTAL CASES = 1216
MORTALITY = 0.7%
MAJOR MORBIDITY = 3.9%
CARDIAC CASES = 529
MORTALITY = 1.5%
MAJOR MORBIDITY = 6.2%
THORACIC CASES = 687
MORTALITY = 0.4%
MAJOR MORBIDITY = 2.8%
Diversity & Complexity of Diversity & Complexity of Major Thoracic OperationsMajor Thoracic Operations
Diversity & Complexity of Diversity & Complexity of Major Thoracic Lung OperationsMajor Thoracic Lung Operations
Bronchoplasty and/or Sleeve
Resectionn=15
Thoracoscopic Lobectomy
n=107
STS NATIONAL DATABASESTS NATIONAL DATABASEInfluence of Functional Score in Influence of Functional Score in
Resections for Lung CancerResections for Lung Cancer
ZUBROD ZUBROD SCORESCORE MORTALITYMORTALITY LOS > 14 LOS > 14
DAYSDAYS COMPLICATIONSCOMPLICATIONS
00 1.3%1.3% 4.8%4.8% 32%32%
11 1.8%1.8% 6.8%6.8% 35%35%
22 3.5%3.5% 12%12% 41%41%
33 7%7% 14%14% 46%46%
44 16%16% 21%21% 51%51%
STS NATIONAL DATABASESTS NATIONAL DATABASEInfluence of FEVInfluence of FEV11 in Resections for in Resections for
Lung CancerLung Cancer
Preop FEVPreop FEV11 MORTALITYMORTALITY LOS > 14 DAYSLOS > 14 DAYS COMPLICATIONSCOMPLICATIONS
> 80% pred> 80% pred 1.1%1.1% 4%4% 30%30%
61-79% pred61-79% pred 2%2% 8%8% 39%39%
< 60% pred< 60% pred 2%2% 9%9% 41%41%
Diversity & Complexity of Diversity & Complexity of Major Thoracic Operations for Major Thoracic Operations for
Lung CaLung Ca
Bronchoplasty and/or Sleeve
Resectionn=15
Thoracoscopic Lobectomy
n=107
CRUDE BenchmarkingCRUDE Benchmarking“Best Case” vs Non-risk adjusted“Best Case” vs Non-risk adjusted
Best Case Lung Ca Best Case Lung Ca Resection STS ScenarioResection STS Scenario MortalityMortality
LOS LOS
> 14 > 14 daysdays
ComplicationsComplications
Preop FEVPreop FEV11 > >80% pred 80% pred
& &
Zubrod Score 0Zubrod Score 0
~1.2%~1.2% ~4%~4% ~30%~30%
THANK YOU !