Our Summary

The way we treat early lung cancer has evolved, including progress in surgery techniques. This has allowed for the removal of lung cancer tumors that in the past were deemed too risky or impossible to remove. However, the TNM classification, which is a system used to classify the extent of cancer spread, does not always match with the ability to operate and remove the lung cancer. Therefore, it’s crucial to use radiology (like CT scans) to determine whether a patient is suitable for surgery to remove the lung cancer.

There are several types of surgeries available - from removing a small wedge-shaped piece of the lung, to removing an entire lung. Radiologists need to understand these options, along with their pros and cons, and provide a report that includes important information about the size, location, and extent of the tumor and its relation to the anatomy that may influence the surgical technique.

CT scans before surgery can also help predict the expected lung function after the surgery and the potential impact on the patient’s recovery. This article explores the role of chest CT in the preoperative evaluation of lung cancer, focusing on the important CT findings that help guide the surgical decision making. As the range of patients who are considered suitable for surgery expands, this information becomes increasingly important.

FAQs

  1. What role does a radiologist play in determining the suitability of a patient for lung cancer resection?
  2. What are the different surgical approaches available for lung cancer resection and how does the choice of approach depend on radiologic evaluation?
  3. How does preoperative CT findings help predict the postoperative lung function and its impact on the patient’s postoperative course?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lung resection is to ensure they undergo thorough radiologic evaluation to determine their suitability for surgery and to guide the selection of the most appropriate surgical approach. This evaluation will help identify critical factors such as tumor size, location, and extension, as well as anatomic relations that may influence the choice of surgical technique. Additionally, preoperative CT findings can help predict postoperative lung function and the impact on the patient’s recovery. It is important for patients to work closely with their healthcare team to understand the potential benefits and risks of lung resection and to make informed decisions about their treatment.

Suitable For

Patients who are typically recommended for lung resection include those with early stage lung cancer, as well as select cases of T4 disease and oligometastatic disease. The TNM classification may not always correlate with operability and resectability, so radiologic evaluation is crucial in identifying suitable candidates for surgery. Radiologists play a key role in providing critical information on tumor size, location, and extension, as well as anatomic relations that may impact the choice of surgical approach. Preoperative CT findings can also help predict postoperative lung function and guide the postoperative course of the patient. Overall, the evolution of multimodality management has expanded the pool of patients who may be considered for lung resection.

Timeline

Before lung resection:

  1. Patient presents with symptoms such as cough, chest pain, shortness of breath, or weight loss.
  2. Imaging studies, such as chest x-rays and CT scans, are performed to diagnose and stage the lung cancer.
  3. The patient undergoes various tests, such as pulmonary function tests and blood work, to assess their overall health and lung function.
  4. The patient meets with a multidisciplinary team, including oncologists, pulmonologists, and surgeons, to discuss treatment options.
  5. A surgical plan is developed based on the patient’s specific case, including the type of resection (wedge resection, lobectomy, etc.) that may be needed.

After lung resection:

  1. The patient undergoes the surgical procedure, which may involve removing a portion of the lung or the entire lung depending on the extent of the cancer.
  2. The patient recovers in the hospital for a few days to weeks, depending on the type of resection and their overall health.
  3. Follow-up imaging studies and appointments with the surgical team are scheduled to monitor the patient’s recovery and assess for any signs of recurrence.
  4. The patient may undergo additional treatments, such as chemotherapy or radiation therapy, to further treat the lung cancer.
  5. The patient is monitored for any potential complications, such as infection or impaired lung function, and is provided with support and resources for their ongoing care and recovery.

What to Ask Your Doctor

  1. What specific type of lung resection surgery do you recommend for my case (e.g., wedge resection, segmentectomy, lobectomy, bilobectomy, pneumonectomy)?
  2. What are the potential risks and complications associated with the recommended lung resection surgery?
  3. How will the surgery affect my lung function and breathing after the procedure?
  4. What is the expected recovery time and postoperative care plan following the lung resection surgery?
  5. Will I need any additional treatments, such as chemotherapy or radiation therapy, after the lung resection surgery?
  6. How often will I need follow-up appointments and imaging scans to monitor for any recurrence of lung cancer?
  7. Are there any alternative treatment options to lung resection surgery that I should consider?
  8. What is the success rate of lung resection surgery for patients with similar characteristics to mine?
  9. What is your experience and expertise in performing lung resection surgeries?
  10. Are there any lifestyle changes or precautions I should take before and after the lung resection surgery to optimize my recovery and overall health?

Reference

Authors: Stefanidis K, Konstantellou E, Yusuf G, Moser J, Tan C, Vlahos I. Journal: AJR Am J Roentgenol. 2022 Jan;218(1):52-65. doi: 10.2214/AJR.21.26408. Epub 2021 Aug 18. PMID: 34406062