Accomplishes fundamental surgical tenets of R0 resection with systematic nodal staging for NSCLC Equivalent survival for Stage 1A disease

Size: px
Start display at page:

Download "Accomplishes fundamental surgical tenets of R0 resection with systematic nodal staging for NSCLC Equivalent survival for Stage 1A disease"

Transcription

1 Segmentectomy Made Simple Matthew J. Schuchert and Rodney J. Landreneau Department of Cardiothoracic Surgery University of Pittsburgh Medical Center

2 Financial Disclosures none

3 Why Consider Anatomic Segmentectomy? Accomplishes fundamental surgical tenets of R0 resection with systematic nodal staging for NSCLC Equivalent survival for Stage 1A disease Decreased morbidity and mortality risk - esp. in the elderly Lung Preservation - esp. in marginal patients, prior surgery, tumors of low malignant potential

4 Surgical Approach Anatomic Segmentectomy and Lobectomy - Tenets Same fundamental principles as lobectomy VATS vs. Open Individual bronchial and vascular isolation and division Extended segmentectomy with stapled parenchymal margin R0 Resection Adequate surgical margins Lymph node sampling (N1/N2)

5 VATS Segmentectomy VATS APPROACH

6 Patient Selection Favorable Criteria for Anatomic Segmentectomy Small Tumors: < 2 cm in diameter Confined to a discrete segmental boundary Peripheral location (outer 1/3) Pathologic Margin (Margin/Tumor ratio>1) Elderly (Age >80) Marginal pulmonary function (FEV1/DLCO < 60%) Ground glass opacities Adenocarcinoma in situ Prior lung resection Solitary Pulmonary Nodule Metastases

7 Segments Resected Operation n Right Upper Lobe Apical 83 Anterior 43 Posterior 79 ApicoPosterior 18 Right Middle Lobe Medial 10 Lateral 17 Right Lower Lobe Superior 78 Basilar 76 Left Upper Lobe Upper Division 183 Lingula 69 Left Lower Lobe Superior 62 Basilar 67 Total 785

8 Incisional Access Camera: 7th Interspace, Mid-Axillary Line Retraction/Stapler: 7th Interspace, Posterior Axillary Line Access Incision: Inframammary Crease, Anterior Axillary Line Stab Incision Axillary hair line

9 General Principles Hilar approach avoid dissecting in fissure when possible Vein - Artery - Bronchus Exceptions: Superior and Posterior Segments Individual bronchial and vascular isolation and division; develop and complete fissures with stapled approach Stapled extended segmentectomy Preserve integrity of remaining lung Be mindful of aberrant anatomy

10 Segmental Pearls Right Upper Lobe Right Upper Lobe Vein anteroapical and interlobar branches Vein - Artery - Bronchus Smaller vascular branches can be divided with energy or clipped Posterior artery may arise as a proximal trunk from the main PA, as a side-branch of the anteroapical trunk or as a recurrent branch arising from the superior segment artery

11 Segmental Pearls Left Upper Lobe Left Upper Lobe Vein Upper Division and Lingular branches Vein - Artery - Bronchus Variable arterial anatomy multiple posterior branches Lingular artery may arise as a proximal trunk from the main PA, as a side-branch of the first apicoposterior trunk or as a recurrent branch arising from the basilar segment artery

12 Segmental Pearls Right Middle Lobe Right Middle Lobe Vein typically arises from upper lobe vein Vein - Bronchus - Artery Frequently incomplete fissure The middle lobe artery may arise as a common trunk or frequently as paired segmental branches

13 Segmental Pearls Lower Lobes Anatomic relationships most constant Lower Lobe Vein small superior trunk runs posterior to bronchus Vein - Artery - Bronchus Arterial variations include accessory branches from the RML or lingular arteries to the anterior basilar segment, accessory branches to superior segment from the basilar artery and recurring branches to the lingula and RUL posterior segment

14 Pure Energy Ease of use Open and VATS Low profile jaws facilitate instrument positioning Excellent hemostasis during the course of resection Can assist in development of the fissures Minimal thermal spread (2-3 mm) Reduced operative costs

15 Energy - Upper Division Pulmonary Vein

16 Energy - Upper Division Pulmonary Artery

17 Anatomic Segmentectomy 71 M Long-time smoker CT: 1.7 cm Lung Nodule No enlarged lymph nodes FNA: Adenocarcinoma

18 Basilar Segmentectomy Basilar Vein Superior Segmental Vein Superior Segmental Vein Divided Basilar Vein

19 Basilar Segmentectomy Basilar Artery

20 Basilar Segmentectomy Basilar Bronchus

21 Basilar Segmentectomy

22 Basilar Segmentectomy

23 T1a NSCLC ( 2 cm) Segmentectomy (n=227) Lobectomy (n=336) P Value 44 (19.4%) 11 (4.8%) 33 (14.5%) 49 (14.6%) 12 (3.6%) 37 (11.0%) Recurrence Locoregional Distant ACS 2011 P=0.18 Lobectomy Segmentectomy Time (Months) Freedom from Death (%) Freedom from Recurrence (%) Propensity-Matching (n=162) P=0.16 Lobectomy Segmentectomy Time (Months)

24 Sublobar Resection Why Consider Anatomic Segmentectomy? Decreased mortality risk in the elderly Lung Preservation - esp. in marginal patients Solitary Pulmonary Nodule - Diagnostic and Therapeutic Metastasectomy; GGOs Accomplishes fundamental surgical tenets of R0 resection with systematic nodal staging for NSCLC Taking more tissue does not enhance survival esp. small tumors Taking less tissue (e.g. SRS, RFA) does not accomplish R0 resection or systematic nodal staging

25 Conclusions Anatomic Segmentectomy can be performed safely in the setting of the indeterminate pulmonary nodule or clinical stage I NSCLC. Anatomic segmentectomy is associated with equivalent recurrence-free survival rates compared with lobectomy for clinical stage IA disease. Same anatomic dissection techniques as lobectomy Careful attention to adequacy of margin and preservation of residual bronchovascular unit In the era of image-guided ablation modalities, segmental resection for Stage I tumors affords complete resection with adequate margins, regional nodal staging and provides tissue for pharmacogenomic assessment.

26 Thank You

27

Minimally invasive lobectomy and thoracic lymph node

Minimally invasive lobectomy and thoracic lymph node Minimally Invasive Segmentectomy Joshua R. Sonett, MD, FACS Minimally invasive lobectomy and thoracic lymph node dissection is now widely established as a safe, anatomic, and oncologically sound procedure

More information

Parenchyma-sparing lung resections are a potential therapeutic

Parenchyma-sparing lung resections are a potential therapeutic Lung Segmentectomy for Patients with Peripheral T1 Lesions Bryan A. Whitson, MD, Rafael S. Andrade, MD, and Michael A. Maddaus, MD Parenchyma-sparing lung resections are a potential therapeutic option

More information

Mastering Thoracoscopic Upper Lobectomy

Mastering Thoracoscopic Upper Lobectomy Mastering Thoracoscopic Upper Lobectomy Duke Thoracoscopic Lobectomy Workshop March 21, 2018 Thomas A. D Amico MD Gary Hock Professor of Surgery Section Chief, Thoracic Surgery, Duke University Medical

More information

Totally thoracoscopic left upper lobe tri-segmentectomy

Totally thoracoscopic left upper lobe tri-segmentectomy Masters of Cardiothoracic Surgery Totally thoracoscopic left upper lobe tri-segmentectomy Dominique Gossot Thoracic Department, Institut Mutualiste Montsouris, Paris, France Correspondence to: Dominique

More information

Uniportal video-assisted thoracoscopic surgery segmentectomy

Uniportal video-assisted thoracoscopic surgery segmentectomy Case Report on Thoracic Surgery Page 1 of 5 Uniportal video-assisted thoracoscopic surgery segmentectomy John K. C. Tam 1,2 1 Division of Thoracic Surgery, National University Heart Centre, Singapore;

More information

Monitor Images for Respiratory System Dissection

Monitor Images for Respiratory System Dissection Monitor Images for Respiratory System Dissection **This document includes extra images of the radiology of the bronchopulmonary segments. These imaged are an excellent way to review the three-dimensional

More information

Thoracoscopic anterior segmentectomy of the right upper lobe (S 3 )

Thoracoscopic anterior segmentectomy of the right upper lobe (S 3 ) Surgical Technique on Thoracic Surgery Page 1 of 6 Thoracoscopic anterior segmentectomy of the right upper lobe (S 3 ) Jon Lutz 1,2, Agathe Seguin-Givelet 1,3, Dominique Gossot 1 1 ; 2 Division of General

More information

Indications for sublobar resection for localized NSCLC

Indications for sublobar resection for localized NSCLC Indications for sublobar resection for localized NSCLC David H Harpole Jr, MD Professor of Surgery Associate Professor in Pathology Vice Chief, Division of Surgical Services Duke University School of Medicine

More information

Thoracoscopic S 6 segmentectomy: tricks to know

Thoracoscopic S 6 segmentectomy: tricks to know Surgical Technique Page 1 of 6 Thoracoscopic S 6 segmentectomy: tricks to know Agathe Seguin-Givelet 1,2, Jon Lutz 1, Dominique Gossot 1 1 Thoracic Department, Institut Mutualiste Montsouris, Paris, France;

More information

Ruijin robotic thoracic surgery: S segmentectomy of the left upper lobe

Ruijin robotic thoracic surgery: S segmentectomy of the left upper lobe Case Report Page 1 of 5 Ruijin robotic thoracic surgery: S 1+2+3 segmentectomy of the left upper lobe Han Wu, Su Yang, Wei Guo, Runsen Jin, Yajie Zhang, Xingshi Chen, Hailei Du, Dingpei Han, Kai Chen,

More information

Anatomic Segmentectomy for the Solitary Pulmonary Nodule and Early-Stage Lung Cancer

Anatomic Segmentectomy for the Solitary Pulmonary Nodule and Early-Stage Lung Cancer GENERAL THORACIC ORIGINAL ARTICLES: GENERAL THORACIC GENERAL THORACIC SURGERY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related

More information

VATS Segmentectomy. Duke Masters Course Sept 2015

VATS Segmentectomy. Duke Masters Course Sept 2015 VATS Segmentectomy Duke Masters Course Sept 2015 Scott J. Swanson, M.D. Director, Minimally Invasive Thoracic Surgery Brigham and Women s Hospital Chief Surgical Officer Dana Farber Cancer Institute Professor

More information

OBJECTIVES. Solitary Solid Spiculated Nodule. What would you do next? Case Based Discussion: State of the Art Management of Lung Nodules.

OBJECTIVES. Solitary Solid Spiculated Nodule. What would you do next? Case Based Discussion: State of the Art Management of Lung Nodules. Organ Imaging : September 25 2015 OBJECTIVES Case Based Discussion: State of the Art Management of Lung Nodules Dr. Elsie T. Nguyen Dr. Kazuhiro Yasufuku 1. To review guidelines for follow up and management

More information

Lungebevarende resektioner ved lungecancer metode og resultater

Lungebevarende resektioner ved lungecancer metode og resultater Dept. of Cardiothoracic Surgery Lungebevarende resektioner ved lungecancer metode og resultater Henrik Jessen Hansen Dept. of Cardiothoracic Surgery RT 2152, The National University Hospital. Copenhagen,

More information

Video-assisted thoracic surgery tunnel technique: an alternative fissureless approach for anatomical lung resections

Video-assisted thoracic surgery tunnel technique: an alternative fissureless approach for anatomical lung resections Surgical Technique Page 1 of 8 Video-assisted thoracic surgery tunnel technique: an alternative fissureless approach for anatomical lung resections Herbert Decaluwé Department of Thoracic Surgery, Leuven

More information

SURGICAL TECHNIQUE. Radical treatment for left upper-lobe cancer via complete VATS. Jun Liu, Fei Cui, Shu-Ben Li. Introduction

SURGICAL TECHNIQUE. Radical treatment for left upper-lobe cancer via complete VATS. Jun Liu, Fei Cui, Shu-Ben Li. Introduction SURGICAL TECHNIQUE Radical treatment for left upper-lobe cancer via complete VATS Jun Liu, Fei Cui, Shu-Ben Li The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China ABSTRACT KEYWORDS

More information

Charles Mulligan, MD, FACS, FCCP 26 March 2015

Charles Mulligan, MD, FACS, FCCP 26 March 2015 Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening

More information

Lung Cancer Clinical Guidelines: Surgery

Lung Cancer Clinical Guidelines: Surgery Lung Cancer Clinical Guidelines: Surgery 1 Scope of guidelines All Trusts within Manchester Cancer are expected to follow this guideline. This guideline is relevant to: Adults (18 years and older) with

More information

Thoracoscopic left upper lobectomy with systematic lymph nodes dissection under left pulmonary artery clamping

Thoracoscopic left upper lobectomy with systematic lymph nodes dissection under left pulmonary artery clamping GCTAB Column Thoracoscopic left upper lobectomy with systematic lymph nodes dissection under left pulmonary artery clamping Yi-Nan Dong, Nan Sun, Yi Ren, Liang Zhang, Ji-Jia Li, Yong-Yu Liu Department

More information

Uniportal video-assisted thoracoscopic right upper posterior segmentectomy with systematic mediastinal lymphadenectomy

Uniportal video-assisted thoracoscopic right upper posterior segmentectomy with systematic mediastinal lymphadenectomy Surgical Technique Uniportal video-assisted thoracoscopic right upper posterior segmentectomy with systematic mediastinal lymphadenectomy Guofei Zhang 1, Zhijun Wu 2, Yimin Wu 1, Gang Shen 1, Ying Chai

More information

Surgical atlas of thoracoscopic lobectomy and segmentectomy

Surgical atlas of thoracoscopic lobectomy and segmentectomy Art of Operative Technique Surgical atlas of thoracoscopic lobectomy and segmentectomy Tristan D. Yan 1,2 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; 2 Department

More information

Robotic thoracic surgery: S 1+2 segmentectomy of left upper lobe

Robotic thoracic surgery: S 1+2 segmentectomy of left upper lobe Case Report Page 1 of 5 Robotic thoracic surgery: S 1+2 segmentectomy of left upper lobe Hailei Du, Su Yang, Wei Guo, Runsen Jin, Yajie Zhang, Xingshi Chen, Han Wu, Dingpei Han, Kai Chen, Jie Xiang, Hecheng

More information

Thoracoscopic Lobectomy for Locally Advanced Lung Cancer. Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014

Thoracoscopic Lobectomy for Locally Advanced Lung Cancer. Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014 for Locally Advanced Lung Cancer Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014 Thomas A. D Amico MD Gary Hock Endowed Professor and Vice Chair of Surgery Chief Thoracic Surgery

More information

Uniportal video-assisted thoracic surgery for complicated pulmonary resections

Uniportal video-assisted thoracic surgery for complicated pulmonary resections Review Article on Thoracic Surgery Uniportal video-assisted thoracic surgery for complicated pulmonary resections Ding-Pei Han, Jie Xiang, Run-Sen Jin, Yan-Xia Hu, He-Cheng Li Jiaotong University School

More information

Adam J. Hansen, MD UHC Thoracic Surgery

Adam J. Hansen, MD UHC Thoracic Surgery Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered

More information

Techniques and difficulties dealing with hilar and interlobar benign lymphadenopathy in uniportal VATS

Techniques and difficulties dealing with hilar and interlobar benign lymphadenopathy in uniportal VATS Original Article on Thoracic Surgery Techniques and difficulties dealing with hilar and interlobar benign lymphadenopathy in uniportal VATS William Guido Guerrero 1, Diego Gonzalez-Rivas 1,2, Luis Angel

More information

ROBOT SURGEY AND MINIMALLY INVASIVE TREATMENT FOR LUNG CANCER

ROBOT SURGEY AND MINIMALLY INVASIVE TREATMENT FOR LUNG CANCER ROBOT SURGEY AND MINIMALLY INVASIVE TREATMENT FOR LUNG CANCER Giulia Veronesi European Institute of Oncology Milan Lucerne, Samo 24 th - 25 th January, 2014 DIAGNOSTIC REVOLUTION FOR LUNG CANCER - Imaging

More information

The Shanghai Pulmonary Hospital uniportal subxiphoid approach for lung segmentectomies

The Shanghai Pulmonary Hospital uniportal subxiphoid approach for lung segmentectomies Original Article on Subxiphoid Surgery The Shanghai Pulmonary Hospital uniportal subxiphoid approach for lung segmentectomies Giuseppe Aresu,2,3, Helen Weaver, Liang Wu 2, Lei Lin 2, Gening Jiang 2, Lei

More information

UERMMMC Department of Radiology. Basic Chest Radiology

UERMMMC Department of Radiology. Basic Chest Radiology UERMMMC Department of Radiology Basic Chest Radiology PHYSICS DENSITIES BONE SOFT TISSUES WATER FAT AIR TELEROENTGENOGRAM Criteria for an Ideal Chest Radiograph 1. Upright 2. Posteroanterior View 3. Full

More information

Nontuberculous Mycobacteria

Nontuberculous Mycobacteria Nontuberculous Mycobacteria When antibiotics are not enough a surgical approach John D. Mitchell, M.D. Davis Endowed Chair in Thoracic Surgery Professor and Chief Section of General Thoracic Surgery University

More information

Complex Thoracoscopic Resections for Locally Advanced Lung Cancer

Complex Thoracoscopic Resections for Locally Advanced Lung Cancer Complex Thoracoscopic Resections for Locally Advanced Lung Cancer Duke Thoracoscopic Lobectomy Workshop March 21, 2018 Thomas A. D Amico MD Gary Hock Professor of Surgery Section Chief, Thoracic Surgery,

More information

LONG-TERM SURGICAL OUTCOMES OF 1018 PATIENTS WITH EARLY STAGE NSCLC IN ACOSOG Z0030 (ALLIANCE) TRIAL

LONG-TERM SURGICAL OUTCOMES OF 1018 PATIENTS WITH EARLY STAGE NSCLC IN ACOSOG Z0030 (ALLIANCE) TRIAL LONG-TERM SURGICAL OUTCOMES OF 1018 PATIENTS WITH EARLY STAGE NSCLC IN ACOSOG Z0030 (ALLIANCE) TRIAL Stacey Su, MD; Walter J. Scott, MD; Mark S. Allen, MD; Gail E. Darling, MD; Paul A. Decker, MS; Robert

More information

STAGE I INOPERABLE NSCLC RADIOFREQUENCY ABLATION OR STEREOTACTIC BODY RADIOTHERAPY?

STAGE I INOPERABLE NSCLC RADIOFREQUENCY ABLATION OR STEREOTACTIC BODY RADIOTHERAPY? STAGE I INOPERABLE NSCLC RADIOFREQUENCY ABLATION OR STEREOTACTIC BODY RADIOTHERAPY? MICHAEL LANUTI, MD American Association of Thoracic Surgeons Minneapolis, MN 2013 STAGE I INOPERABLE NSCLC RADIOFREQUENCY

More information

FDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D.

FDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D. FDG PET/CT in Lung Cancer Read with the experts Homer A. Macapinlac, M.D. Patient with suspected lung cancer presents with left sided chest pain T3 What is the T stage of this patient? A) T2a B) T2b C)

More information

Lung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded.

Lung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded. Lung Case Scenario 1 A 54 year white male presents with a recent abnormal CT of the chest. The patient has a history of melanoma, kidney, and prostate cancers. 10/24/13 Chest X-ray: 2.9 cm mass like density

More information

Variations of pulmonary vein drainage critical for lung resection assessed by three-dimensional computed tomography angiography

Variations of pulmonary vein drainage critical for lung resection assessed by three-dimensional computed tomography angiography Thoracic Cancer ISSN 1759-7706 ORIGINAL ARTICLE Variations of pulmonary vein drainage critical for lung resection assessed by three-dimensional computed tomography angiography Nobuyuki Shiina 1, Kichizo

More information

Session II: Thoracoscopic Rsxns: Advancing the Envelope

Session II: Thoracoscopic Rsxns: Advancing the Envelope Session II: Thoracoscopic Rsxns: Advancing the Envelope Prevention & Management of Intra-op Events Shanda H. Blackmon, M.D., M.P.H., FACS Duke Masters of Minimally Invasive Surgery Meeting 2014 2014 MFMER

More information

Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard

Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard AATS General Thoracic Surgery Symposium May 5, 2010 Thomas A. D Amico MD Professor of Surgery, Duke University Medical

More information

T3 NSCLC: Chest Wall, Diaphragm, Mediastinum

T3 NSCLC: Chest Wall, Diaphragm, Mediastinum for T3 NSCLC: Chest Wall, Diaphragm, Mediastinum AATS Postgraduate Course April 29, 2012 Thomas A. D Amico MD Professor of Surgery, Chief of Thoracic Surgery Duke University Health System Disclosure No

More information

Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013

Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013 Lecturer: Ms DS Pillay ROOM 2P24 25 February 2013 Thoracic Wall Consists of thoracic cage Muscle Fascia Thoracic Cavity 3 Compartments of the Thorax (Great Vessels) (Heart) Superior thoracic aperture

More information

Lung Cancer Role of Surgery. Ricardo M. Terra Associate Professor of Thoracic Surgery University of Sao Paulo Medical School

Lung Cancer Role of Surgery. Ricardo M. Terra Associate Professor of Thoracic Surgery University of Sao Paulo Medical School Lung Cancer Role of Surgery Ricardo M. Terra Associate Professor of Thoracic Surgery University of Sao Paulo Medical School Disclosure Scientific Consultant/Advisory Board: Johnson&Johnson Educational

More information

Robotic-assisted pulmonary segmentectomies

Robotic-assisted pulmonary segmentectomies Review Article on Thoracic Surgery Page 1 of 10 Robotic-assisted pulmonary segmentectomies Pierluigi Novellis 1, Edoardo Bottoni 1, Marco Alloisio 1,2, Frank O. Velez-Cubian 3, Eric M. Toloza 3,4,5, Giulia

More information

Signs in Chest Radiology

Signs in Chest Radiology Signs in Chest Radiology Jonathan H. Chung, MD Disclosures No pertinent disclosures Jonathan H. Chung, MD Assistant Professor Institute t of fadvanced d Biomedical Imaging National Jewish Health Denver,

More information

Hilar cholangiocarcinoma. Frank Wessels, Maarten van Leeuwen, UMCU utrecht

Hilar cholangiocarcinoma. Frank Wessels, Maarten van Leeuwen, UMCU utrecht Hilar cholangiocarcinoma Frank Wessels, Maarten van Leeuwen, UMCU utrecht Content Anatomy Biliary strictures (Hilar) Cholangiocarcinoom Staging Biliary tract 1 st order Ductus hepatica dextra Ductus hepaticus

More information

Pulmonary vascular anatomy & anatomical variants

Pulmonary vascular anatomy & anatomical variants Review Article Pulmonary vascular anatomy & anatomical variants Asha Kandathil, Murthy Chamarthy Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA Contributions:

More information

THORACIC SURGERY DIRECTORS ASSOCIATION BOOT CAMP JULY 25-28, 2013 SECTION: LUNG

THORACIC SURGERY DIRECTORS ASSOCIATION BOOT CAMP JULY 25-28, 2013 SECTION: LUNG THORACIC SURGERY DIRECTORS ASSOCIATION BOOT CAMP JULY 25-28, 2013 SECTION: LUNG Thoracic Faculty Richard Feins, MD (program director) University of North Carolina Jon Nesbitt, MD (course director) Vanderbilt

More information

Single-Incision Thoracoscopic Lobectomy and Segmentectomy With Radical Lymph Node Dissection

Single-Incision Thoracoscopic Lobectomy and Segmentectomy With Radical Lymph Node Dissection Single-Incision Thoracoscopic Lobectomy and Segmentectomy With Radical Lymph Node Dissection Bing-Yen Wang, MD,* Cheng-Che Tu, MD,* Chao-Yu Liu, MD, Chih-Shiun Shih, MD, and Chia-Chuan Liu, MD Division

More information

Robotic-assisted right upper lobectomy

Robotic-assisted right upper lobectomy Robotic Thoracic Surgery Column Robotic-assisted right upper lobectomy Shiguang Xu, Tong Wang, Wei Xu, Xingchi Liu, Bo Li, Shumin Wang Department of Thoracic Surgery, Northern Hospital, Shenyang 110015,

More information

Thoracoscopic wedge resection and segmentectomy for smallsized pulmonary nodules

Thoracoscopic wedge resection and segmentectomy for smallsized pulmonary nodules Perspective on Thoracic Surgery Thoracoscopic wedge resection and segmentectomy for smallsized pulmonary nodules Hirohisa Kato, Hiroyuki Oizumi, Jun Suzuki, Akira Hamada, Hikaru Watarai, Kenta Nakahashi,

More information

THORACIC SURGERY DIRECTORS ASSOCIATION BOOT CAMP SEPTEMBER 13-16, 2018 SECTION: LUNG

THORACIC SURGERY DIRECTORS ASSOCIATION BOOT CAMP SEPTEMBER 13-16, 2018 SECTION: LUNG THORACIC SURGERY DIRECTORS ASSOCIATION BOOT CAMP SEPTEMBER 13-16, 2018 SECTION: LUNG Thoracic Faculty Richard Feins, MD (Program Director) University of North Carolina Jon Nesbitt, MD (Course Director)

More information

Stereotactic Body Radiation Therapy and Radiofrequency Ablation 2014 Masters of Minimally Invasive Surgery

Stereotactic Body Radiation Therapy and Radiofrequency Ablation 2014 Masters of Minimally Invasive Surgery Stereotactic Body Radiation Therapy and Radiofrequency Ablation 2014 Masters of Minimally Invasive Surgery Matthew Hartwig, M.D. Duke Cancer Institute Case Presentation I: Patient ER 74 y/o male with A1A

More information

Sagar Damle, MD University of Colorado Denver May 23, 2011

Sagar Damle, MD University of Colorado Denver May 23, 2011 Sagar Damle, MD University of Colorado Denver May 23, 2011 We have debated many times. Here are the topics, and a recap of the last few Pre-operative nutrition Babu pro; Damle con Utility of ECMO Babu

More information

Segmentectomies. Anna E. Frick 1, Dirk Van Raemdonck 1,2. Introduction

Segmentectomies. Anna E. Frick 1, Dirk Van Raemdonck 1,2. Introduction Review Article Page 1 of 12 Segmentectomies Anna E. Frick 1, Dirk Van Raemdonck 1,2 1 ; 2 Department of Clinical and Experimental Medicine, KU Leuven University, Leuven, Belgium Contributions: (I) Conception

More information

THORACIC MALIGNANCIES

THORACIC MALIGNANCIES THORACIC MALIGNANCIES Summary for Malignant Malignancies. Lung Ca 1 Lung Cancer Non-Small Cell Lung Cancer Diagnostic Evaluation for Non-Small Lung Cancer 1. History and Physical examination. 2. CBCDE,

More information

Thoracoscopic Lobectomy: Technical Aspects in Years of Progress

Thoracoscopic Lobectomy: Technical Aspects in Years of Progress Thoracoscopic Lobectomy: Technical Aspects in 2015 16 Years of Progress 8 th Masters of Minimally Invasive Thoracic Surgery Orlando September 25, 2015 Thomas A. D Amico MD Gary Hock Professor of Surgery

More information

Multiple Primary Quiz

Multiple Primary Quiz Multiple Primary Quiz Case 1 A 72 year old man was found to have a 12 mm solid lesion in the pancreatic tail by computed tomography carried out during a routine follow up study of this patient with adult

More information

Radiology Pathology Conference

Radiology Pathology Conference Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights

More information

Robotic-assisted left inferior lobectomy

Robotic-assisted left inferior lobectomy Robotic Thoracic Surgery Column Robotic-assisted left inferior lobectomy Shiguang Xu, Hao Meng, Tong Wang, Wei Xu, Xingchi Liu, Shumin Wang Department of Thoracic Surgery, Northern Hospital, Shenyang 110015,

More information

RF Ablation: indication, technique and imaging follow-up

RF Ablation: indication, technique and imaging follow-up RF Ablation: indication, technique and imaging follow-up Trongtum Tongdee, M.D. Radiology Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand Objective Basic knowledge

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our

More information

Collaborative Stage. Site-Specific Instructions - LUNG

Collaborative Stage. Site-Specific Instructions - LUNG Slide 1 Collaborative Stage Site-Specific Instructions - LUNG In this presentation, we are going to review the AJCC Cancer Staging criteria for the lung primary site. Slide 2 Reading Assignments As each

More information

CT Chest. Verification of an opacity seen on the straight chest X ray

CT Chest. Verification of an opacity seen on the straight chest X ray CT Chest Indications: To assess equivocal plain x-ray findings Staging of lung neoplasm Merastatic workup of extra thoraces malignancies Diagnosis of diffuse lung diseases with HRCT Assessment of bronchietasis

More information

Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis

Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis ORIGINAL ARTICLES: Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis Shun-ichi Watanabe, MD, Kenji Suzuki, MD, and Hisao Asamura, MD

More information

ACOSOG Thoracic Committee. Kemp H. Kernstine, MD PhD

ACOSOG Thoracic Committee. Kemp H. Kernstine, MD PhD ACOSOG Thoracic Committee Kemp H. Kernstine, MD PhD ACOSOG Thoracic Committee Chair: Bryan Meyers, M.D., MPH Vice Chairs: Malcolm Brock, MD Tom DiPetrillo, M.D. Ramaswamy Govindan, M.D. Carolyn Reed, MD

More information

Low-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2

Low-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2 Low-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2 The Committee for Management of CT-screening-detected Pulmonary Nodules 2009-2011 The Japanese Society of CT Screening

More information

Robotic-assisted pulmonary resection - Right upper lobectomy

Robotic-assisted pulmonary resection - Right upper lobectomy Art of Operative Techniques Robotic-assisted pulmonary resection - Right upper lobectomy Robert J. Cerfolio, Ayesha S. Bryant JH Estes Family Endowed Chair for Lung Cancer Research, Division of Cardiothoracic

More information

Uniportal video-assisted thoracoscopic sleeve lobectomy and other complex resections

Uniportal video-assisted thoracoscopic sleeve lobectomy and other complex resections Surgical Technique Uniportal video-assisted thoracoscopic sleeve lobectomy and other complex resections Diego Gonzalez-Rivas,2, Eva Fieira, Maria Delgado, Mercedes de la Torre,2, Lucia Mendez, Ricardo

More information

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules Perspective on Thoracic Surgery Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules Hirohisa Kato, Hiroyuki Oizumi, Jun Suzuki, Akira Hamada, Hikaru Watarai, Kenta Nakahashi,

More information

Reasons for conversion during VATS lobectomy: what happens with increased experience

Reasons for conversion during VATS lobectomy: what happens with increased experience Review Article on Thoracic Surgery Page 1 of 5 Reasons for conversion during VATS lobectomy: what happens with increased experience Dario Amore, Davide Di Natale, Roberto Scaramuzzi, Carlo Curcio Division

More information

Uniportal video-assisted lobectomy through a posterior approach

Uniportal video-assisted lobectomy through a posterior approach Surgical Technique Uniportal video-assisted lobectomy through a posterior approach Francesco Paolo Caronia 1 *, Ettore Arrigo 1, Alfonso Fiorelli 2 * 1 Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo,

More information

Three-arm robot-assisted thoracoscopic surgery for locally advanced N2 non-small cell lung cancer

Three-arm robot-assisted thoracoscopic surgery for locally advanced N2 non-small cell lung cancer Surgical Technique Three-arm robot-assisted thoracoscopic surgery for locally advanced N2 non-small cell lung cancer Xinghua Cheng, Chongwu Li, Jia Huang, Peiji Lu, Qingquan Luo Shanghai Chest Hospital,

More information

Robotic-assisted right inferior lobectomy

Robotic-assisted right inferior lobectomy Robotic Thoracic Surgery Column Page 1 of 6 Robotic-assisted right inferior lobectomy Shiguang Xu, Tong Wang, Wei Xu, Xingchi Liu, Bo Li, Shumin Wang Department of Thoracic Surgery, Northern Hospital,

More information

Larry Tan, MD Thoracic Surgery, HSC. Community Cancer Care Educational Conference October 27, 2017

Larry Tan, MD Thoracic Surgery, HSC. Community Cancer Care Educational Conference October 27, 2017 Larry Tan, MD Thoracic Surgery, HSC Community Cancer Care Educational Conference October 27, 2017 To describe patient referral & triage for the patient with suspected lung cancer To describe the initial

More information

Uniportal complete video-assisted thoracoscopic surgery lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph node

Uniportal complete video-assisted thoracoscopic surgery lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph node Surgical Technique Uniportal complete video-assisted thoracoscopic surgery lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph node Guang-Suo Wang, Jian Wang, Zhan-Peng

More information

Lung cancer Surgery. 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY March, 2017 Berlin, Germany

Lung cancer Surgery. 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY March, 2017 Berlin, Germany 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY 24-29 March, 2017 Berlin, Germany Lung cancer Surgery Sven Hillinger MD, Thoracic Surgery, University Hospital Zurich Case 1 59 y, female, 40 py, incidental

More information

Sir Clement Price Thomas performed the first sleeve lobectomy

Sir Clement Price Thomas performed the first sleeve lobectomy Parenchymal-Sparing Procedures in Lung Cancer: Sleeve Resection of the Lung for Proximal Lesions Simon Ashiku, MD, and Malcolm M. DeCamp, Jr., MD Sir Clement Price Thomas performed the first sleeve lobectomy

More information

Posterior uniportal video-assisted thoracoscopic surgery for anatomical lung resections

Posterior uniportal video-assisted thoracoscopic surgery for anatomical lung resections Original Article Posterior uniportal video-assisted thoracoscopic surgery for anatomical lung resections Davor Stamenovic 1, Korkut Bostanci 2, Antje Messerschmidt 1 1 Department of Thoracic Surgery, St.

More information

VATS Metastasectomy. Inderpal (Netu) S. Sarkaria, MD, FACS

VATS Metastasectomy. Inderpal (Netu) S. Sarkaria, MD, FACS VATS Metastasectomy Inderpal (Netu) S. Sarkaria, MD, FACS Vice Chairman, Clinical Affairs Director, Robotic Thoracic Surgery Co-Director, Esophageal and Lung Surgery Institute Disclosures Speaking & Education:

More information

ACOSOG (NCCTG, CALGB) Alliance Thoracic Committee Kemp H. Kernstine, MD PhD

ACOSOG (NCCTG, CALGB) Alliance Thoracic Committee Kemp H. Kernstine, MD PhD ACOSOG (NCCTG, CALGB) Alliance Thoracic Committee Kemp H. Kernstine, MD PhD 7-12-12 ACOSOG Thoracic Committee Chair: Bryan Meyers, M.D., MPH Vice Chairs: Malcolm Brock, MD Tom DiPetrillo, M.D. Ramaswamy

More information

Oncology Clinical Service Line System-wide Consensus Guidelines: Treatment of Stage I Lung Cancer

Oncology Clinical Service Line System-wide Consensus Guidelines: Treatment of Stage I Lung Cancer Oncology Clinical Service Line System-wide Consensus Guidelines: Treatment of Stage I Lung Cancer These guidelines apply to clinical interventions that have well-documented outcomes, but whose outcomes

More information

and Strength of Recommendations

and Strength of Recommendations ASTRO with ASCO Qualifying Statements in Bold Italics s patients with T1-2, N0 non-small cell lung cancer who are medically operable? 1A: Patients with stage I NSCLC should be evaluated by a thoracic surgeon,

More information

VATS CONVENTIONAL APPROACH

VATS CONVENTIONAL APPROACH VATS CONVENTIONAL APPROACH Totally thoracoscopic pulmonary anatomic segmentectomies: technical considerations Dominique Gossot, Rym Zaimi, Ludovic Fournel, Madalina Grigoroiu, Emmanuel Brian, Charles Neveu

More information

J Clin Oncol 32: by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 32: by American Society of Clinical Oncology INTRODUCTION VOLUME 32 NUMBER 23 AUGUST 10 2014 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Recurrence and Survival Outcomes After Anatomic Versus for Clinical Stage I Non Small-Cell Lung Cancer: A Propensity-Matched

More information

Partial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches

Partial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches Partial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches Cary N Robertson MD FACS Associate Professor Division of Urology Associate Director Urologic Oncology Duke Cancer

More information

Oncologic Efficacy of Anatomic Segmentectomy in Stage IA Lung Cancer Patients With T1a Tumors

Oncologic Efficacy of Anatomic Segmentectomy in Stage IA Lung Cancer Patients With T1a Tumors Oncologic Efficacy of Anatomic Segmentectomy in Stage IA Lung Cancer Patients With T1a Tumors James M. Donahue, MD, Christopher R. Morse, MD, Dennis A. Wigle, MD, PhD, Mark S. Allen, MD, Francis C. Nichols,

More information

Video-assisted thoracoscopic lobectomy using a standardized three-port anterior approach - The Copenhagen experience

Video-assisted thoracoscopic lobectomy using a standardized three-port anterior approach - The Copenhagen experience Art of Operative Techniques Video-assisted thoracoscopic lobectomy using a standardized three-port anterior approach - The Copenhagen experience Henrik J. Hansen, René H. Petersen Department of Cardiothoracic

More information

PET/CT Frequently Asked Questions

PET/CT Frequently Asked Questions PET/CT Frequently Asked Questions General Q: Is FDG PET specific for cancer? A: No, it is a marker of metabolism. In general, any disease that causes increased metabolism can result in increased FDG uptake

More information

Thyroid INTRODUCTION ANATOMY SUMMARY OF CHANGES

Thyroid INTRODUCTION ANATOMY SUMMARY OF CHANGES AJC 7/14/06 1:19 PM Page 67 Thyroid C73.9 Thyroid gland SUMMARY OF CHANGES Tumor staging (T) has been revised and the categories redefined. T4 is now divided into T4a and T4b. Nodal staging (N) has been

More information

PULMONARY INFARCTS ASSOCIATED WITH BRONCHOGENIC CARCINOMA

PULMONARY INFARCTS ASSOCIATED WITH BRONCHOGENIC CARCINOMA Thor-ax (1954), 9, 304. PULMONARY INFARCTS ASSOCIATED WITH BRONCHOGENIC CARCINOMA W. J. HANBURY, R. J. R. CURETON, AND G. SIMON From St. Bartholomew's Hospital, London BY (RECEIVED FOR PUBLICATION JUNE

More information

An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography

An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography Gen Thorac Cardiovasc Surg (2015) 63:354 360 DOI 10.1007/s11748-015-0531-1 ORIGINAL ARTICLE An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography

More information

Surgery for early stage NSCLC

Surgery for early stage NSCLC 1-3 March 2017, Manchester, UK Surgery for early stage NSCLC Dominique H. Grunenwald, MD, PhD Professor Emeritus in Thoracic and Cardiovascular surgery Pierre & Marie Curie University. Paris. France what

More information

History of Surgery for Lung Cancer

History of Surgery for Lung Cancer Welcome to Master Class for Oncologists Session 1: 7:30 AM - 8:15 AM San Francisco, CA October 23, 2009 Innovations in The Surgical Treatment of Lung Cancer Speaker: Scott J. Swanson, MD 2 Presenter Disclosure

More information

Surgery has been proven to be beneficial for selected patients

Surgery has been proven to be beneficial for selected patients Thoracoscopic Lung Volume Reduction Surgery Robert J. McKenna, Jr, MD Surgery has been proven to be beneficial for selected patients with severe emphysema. Compared with medical management, lung volume

More information

The branching pattern of pulmonary vessels varies

The branching pattern of pulmonary vessels varies GENERAL THORACIC Right Upper Lobe Venous Drainage Posterior to the Bronchus Intermedius: Preoperative Identification by Computed Tomography Katsuyuki Asai, MD, Norikazu Urabe, MD, PhD, Kiyoshige Yajima,

More information

Value Dossier on Thoracic Surgery

Value Dossier on Thoracic Surgery Value Dossier on Thoracic Surgery T A B L E O F C O N T E N T S T A B L E O F C O N T E N T S TABLE OF CONTENTS PREFACE LUNG CANCER TREATMENT Surgical Procedures 29 Health Economics 52 Concise Summary

More information

Bronchogenic Carcinoma

Bronchogenic Carcinoma A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most

More information

PET/CT in lung cancer

PET/CT in lung cancer PET/CT in lung cancer Andrei Šamarin North Estonia Medical Centre 3 rd Baltic Congress of Radiology 08.10.2010 Imaging in lung cancer Why do we need PET/CT? CT is routine imaging modality for staging of

More information

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010

Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical

More information

GROUP 1: Peripheral tumour with normal hilar and mediastinum on staging CT with no disant metastases. Including: Excluding:

GROUP 1: Peripheral tumour with normal hilar and mediastinum on staging CT with no disant metastases. Including: Excluding: GROUP 1: Including: Excluding: Peripheral tumour with normal hilar and mediastinum on staging CT with no disant metastases Solid pulmonary nodules 8mm diameter / 300mm3 volume and BROCK risk of malignancy

More information

Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy

Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy Original Article Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy Tae Yun Park 1,2, Young Sik Park 2 1 Division

More information