Lung Resection

Question 1

Components of pre-resection staging for patients undergoing lung resection?

Answer 1

Complete H&P focusing on involvement of lymph nodes and liver masses

Chest CT

PET scan (r/o distant mets)

Head CT/MRI not obligatory in patients without headache

Thoracoscopy (some patients)

Mediastinoscopy (some patients)

Question 2

All patients with lung cancer may have mediastinal mets. Although PET is quite sensitive for identifying these, it remains less sensitive than ___.

Answer 2

Mediastinoscopy (indicated for all patients with PET scan-positive mediastinum, consider in certain patients with PET scan-negative mediastinum)

Question 3

List 5 causes of PET positivity.

Answer 3

1. Granulomatous disease, histo, TB, sarcoid, other fungal diseases
2. Healing fractures
3. Previous surgical intervention/talc sclerosis/thoracotomy
4. Cancer
5. Other active infection

Question 4

Goal FEV1/DLCO for thoracotomy?

Answer 4

FEV1 >1.5 L or >50% predicted

DLCO >40%

Question 5

If those goals are not met, what should be done?

Answer 5

VQ scan
Diffusion capacity evaluation
Oxygen exercise consumption test