principles of lung cancer treatment（肺癌的外科治疗原则）课件.ppt

Surgical principles of lung cancer treatment Abdel Rahman M.Abdel Rahman, MD.***Department of cardiothoracic surgery , Emory University school of medicine , Atlanta , Georgia .  **Department of surgery ,National Cancer institute Cairo University. Lung cancer remains the most common cause of death by malignancy in both men and women. Despite the advances in the understanding of the molecule biology of pulmonary malignancy , surgical resection offers the best opportunity for cure of non-small cell lung cancer .  Preoperative assessment  It’s now standard practice to carefully stage all cancers of the lung at the time of their initial diagnosis. Since 1986 , the international tumor node metastases (TNM) staging system has been used by most oncologists . The following principles of oncologic surgery must be employed :*Whenever posssible , the tumor and all intrapulmonary lymphatic drainage should be removed completely , most frequently by lobectomy or pneumonectomy.*Care must be taken not to trasgress the tumor during the resection to avoid tumor spillage . *Resection margins should be assessed by frozen section analysis , including bronchial, vascular and any other margins with close proximity to the tumor . Re-excision is preferred whenever possible if positive resection margins are encountered .*All accessible mediastinal lymph node stations should be removed or sampled for pathologic evaluation , these should be identified and properly labeled by the surgeon. *En bloc resection of closely adjacent or invaded structures is preferable to discontinous resection .   Surgical resection is the therapy of choice for early stage NSCLC and is generally offered to all patients with stage I and II disease, some patients with satge III disease and those with solitary metastasis with completely resectable primary tumor. Surgical techniques include : *Pneumonectomy.*Lobectomy .*Wedge resection.*Segmental resection .*Bronchoplastic techniques.*