Diagnostic Methods in Solitary Pulmonary Nodules: Diagnostic Surgical Approach

  • View
    65

  • Download
    0

Embed Size (px)

DESCRIPTION

Diagnostic Methods in Solitary Pulmonary Nodules: Diagnostic Surgical Approach. Cengiz GEBİTEKİN, FETCS Uludağ Üniversitesi Tıp Fakültesi Göğüs Cerrahisi ABD, BURSA. SPN. 5-year survival in stage I Lung carcinoma diagnosed as SPN – med.%70 * Stage I symptomatic patients %10 ** - PowerPoint PPT Presentation

Text of Diagnostic Methods in Solitary Pulmonary Nodules: Diagnostic Surgical Approach

Slide 1Cengiz GEBTEKN, FETCS
SPN
5-year survival in stage I Lung carcinoma diagnosed as SPN – med.%70*
Stage I symptomatic patients %10**
Stage I according to Chest X-ray
%30***, CT -%85****
*Flehinger BJ. Chest 1992;101:1013-1018, **Melamed MR.Chest 1984;86:44-53
***Fontana RS. J Occuo Med 1986;28:746-750, ****Swensen SJ Am J Respir Crit Care Med 2002;165:508-11111513
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
2
SPNs with spiculary margin
SPNs with irregular margin, %83 malignant, with spiculated margins %90 malignant
PET/CT positive SPNs
Increased 5-year survival with early surgery
Low Morbidity and mortality
Stage of the disease
Surgery: When and to Whom? Primary Malignancy with metachronous/syncronous SPN
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
SPN – History of Malignancy
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
Primary Squamous Cell Ca. and Primary Lung Adenocarcinoma
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
Videothoracoscopic Surgery
Finger Palpation
Intrathoracic US
SPN- Reassurence of Patient
Hamartoma with spiculated margins
History of malignancy: Breast, Colon and malignant melanomas
SPNs less than 1.5 cm
At least 2cm away from the pleura med.2.6±0.5cm
Intrathoracic US (ITUS)+finger palpation (FP)
Radio-guided tracing (RGT)+finger palpaption
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
ITUS %96
FP %76
RGT %80
Finger Palpation %80 p=NS
Finding with US med.8min., finger palpation med.6min. and radio-guided 21 min.
%40 pneumothorax with RGT
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
40 patients
SPN 5-10 mm
Without finger palpation
Thoracic surgical decision according to characterstics and growt rate of the SPN
RTG VATS resection
Lobectomy if malignant
Total 54 patients
Peripheric lesions not visible in fluroscopy med. 2.2±0.7 cm
Intrabronchial EBUS and biopsy
Diagnosis in 38 (%70) patients
Avoidance of 9 (%17) thoracotomy
Surgery for 16 patients
%11 patients lesion was not found
Med. procedure time 12 dak.
Median 4.5 biopsies taken
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
Yat Süresi
VATS resections in 429 patients
Med. size 1.8cm
Median hospital stay 4.6days
129 patients with SPN
%76 minithoracotomy, %24 VATS resections, at least 2cm. Healty resection margin
Malignant lesions %63 (%47 primary, %16 secondary malignancy)
Med. Hospital stay 6 days
Mortality %2.3
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
Toplam 276 hasta
Reasons for Lobectomy
Primer lung cancer
Uluda University Medical Faculty Thoracic Surgery Department
1997-2008 Total 62 patients
Carcinoid 2/24 (%8)
Thoracotmy 21/24 (%87.5)
Lobectomy 7/13 (%54)
Segmentectomy 6/13 (%46)
Benign Lezyonlar 38/62 - %61
Alveolar Fibrozis 1 (%3)
Minithoracotomy-Wedge Resection
Carcinoid Tm-Wedge
Toracoscopic wedge
Toracoscopic Segmentectomy
Bronchioloalveolar carcinoma
Open excision
Inf. pseudotümör
VATS Wedge
Adeno Ca
Resection with full muscle sparing minithoracotomy
Approx. 8-10 cm. incision
Left Pneumonectomy
Conclusion
VATS in all patients
Main problem is palpation
Minithoracotomy/VATS no difference
Diagnostic value 100%
Türk Toraks Dernei 12.Yllk Kongresi, 8-11 Nisan 2009, Antalya
Thank You