Lung surgery

Imaging of
congenital lung diseases presenting in the adulthood: a pictorial review. CT images of pulmonary aplasia and pneumonectomy. Rudimentary blind-ending bronchus can be seen on axial CT image in a 27-year-old asymptomatic female with pulmonary aplasia and helps in the differentiation from pulmonary agenesis (a) (arrow). 3D reformatted images (b, c) show the only left airways and compensatory hyperplasia of the left lung into the right side. The left main bronchial stump is observed on axial CT and 3D reformatted images in a 33-year-old patient with right pneumonectomy (d–f) (arrows). Rib deformities and pleural fluid due to pneumonectomy are depicted on axial CT image (d) (arrow)
insightsimaging.springeropen.com • CC-by-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Lung (or pulmonary) surgery is most frequently performed for lung carcinoma, and encompasses a broad spectrum of procedures:

Technique

Approaches
  • posterolateral thoracotomy
    • commonest approach for resection of lung malignancies
  • anterolateral, lateral and axillary thoracotomies are less common
  • muscle-sparing techniques are becoming more popular
    • displacement of chest wall muscles instead of dividing the muscles
    • preserve muscle functionality after surgery
  • median sternotomy
    • preferred approach for simultaneous access to both hemithoraces if lesions to be resected are in both lungs
  • minimally-invasive surgery
    • video-assisted thoracic surgery (VATS)
    • robot-assisted thoracic surgery (RATS)
    • both techniques have decreased morbidity and mortality compared to traditional approaches
Types of lung surgery
Sublobar resection
  • wedge resection (non-anatomic) and segmentectomy (anatomic)
  • ideal for low stage lung carcinoma e.g. stage IA non-small cell lung cancer
  • other indications:
    • multifocal synchronous adenocarcinoma in situ
    • metastases
    • metachronous lesions
  • suboptimal for later-stage cancers
Lobectomy
  • see also main article: lobectomy
  • complete resection of a whole lobe of the lung and also necessitates removal of the associated pulmonary vasculature, bronchi, visceral pleura and mediastinal nodal dissection
Multilobar resection

  • bilobectomy or lobectomy plus sublobar resection may be necessary when more than one lobe is involved, usually due to pleural invasion or incomplete fissure

Sleeve lobectomy
  • in addition to the lobectomy partial resection of a bronchus is also required
  • usually due to malignant involvement of the main bronchus/lobar bronchial lumen: remaining native bronchi are anastomosed
Pneumonectomy
  • see also main article: pneumonectomy
  • the whole lung is removed
    • intrapleural or extrapleural: only visceral, or visceral and parietal pleura removed
    • intrapericardial or extrapericardial
  • indication: bulky/central tumors or ipsilateral recurrence
  • morbidity and mortality are higher than for other forms of lung surgery

Complications

Early
Late

History and etymology

The original development of lobectomy was for the treatment of tuberculosis, specifically a partial lobectomy in 1893 by a British surgeon David Lowson (1850-1907). It was the American surgeon, Evarts Ambrose Graham (1883-1957) who introduced pneumonectomy as a curative treatment for bronchogenic carcinoma in 1932 .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Lungenchirurgie:
Lobektomie
Lunge
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