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Punnarerk Thongcharoen, MD
Department of Surgery
Faculty of Medicine Siriraj Hospital
Disclosure
No conflict of interest
result
NA over Sx
Normal mediastinum CT
Resection
Sleeve lobectomy
If technically feasible (adequate free margin),
sleeve lobectomy should always considered over
pneumonectomy.
N2 disease
Known N2 Sx is not recommended as initial
therapy
Incidental N2 (intraop finding)
Mediastinal LN assessment
Systematic LN dissection
Systematic sampling
LN sampling
Minimally-invasive surgery
Open vs VATS
Open is standard. VATS is alternative.
Recently, NCCN 2015
Benefit of VATS
Direct benefit to the patients
Pain
Cosmetic
Hospital stay
Time for return to work
Time for starting adjuvant therapy
Benefit of VATS
For hospital
Evolution of VATS
Standard VATS lobectomy
4 ports/ 3 ports
RATS
No clear benefit for lobectomy
May be useful for lobectomy with bronchoplasty
NOTES
Transtracheal
Transumbilical
NOTES
Use natural orifice No incision
Pleurectomy
Pleurodesis mechanical/ medical
Shunt