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THORAX (cont)

Dr. Ade Dian Anggraini


Invasive Investigation
Bronchoscopy
Citology,Transbronchial needle aspiration
(TBNA)
Endobronchial Ultrasound (EBUS),
Endoscopic Ultrasound (EUS)
Computed Tomography-guided Biopsy
Endobronchial Ultrasound (EBUS)
Surgical Diagnosis and Staging
Mediastinoscopy Indication:
-Direct visualization
-Biopsy

Complication :
-Pneumothorax
-Haemorrhage
Mediatinotomy These techniques may also be
used in the diagnosis of other
Mediastinal conditions,
including:
Lymphoma;
Anterior mediastinal tumours;
Thymoma;
Sarcoid, tuberculosis or any
other cause of
lymphadenopathy
VATS Mediastinal For inaccesible
Lymph Node and mediatinal Lymph
Lung Biopsy nodes
When the diagnosis
of lung tumor has not
been possible through
radiological or
bronchoscopic
technique
Surgical Approach to Lung
Cancer Resection
Thoracotomy The incision is used for
The standart route access to the :
posterolateral thoracotomy
-Lung and major
A double-lumen endotracheal bronchus
tube is used to allow -Pleura
ventilation of one lung while
the other is collapsed, to -Thoracic aorta
facilitate surgery and to -Oesophagus
protect the non-operated
lung and retain control of -Posterior mediatinum
ventilation
Surgical management of lung cancer

PRINCIPLE !
Remove all cancer ( primary and regional Lymph node )
+
Conserve as much lung as possible
Choice of lung cancer
Segmentectomy and
wedge resection
- For small tumor
- Segementectomy :
anatomical dissection
and ligation segemntal
artery, vein and
bronchus
- Wedge resection : non
anatomical excision
Lobectomy
- Treatment of choice in
patient with early
stage of lung cancer
- Dissection of fissure
and hilar structure, the
branches of the
pulmonary artery and
vein to the lobe are
isolated and ligated
Pneumonectomy
Remove of a whole
lung
- This procedure is
reserved for either
centrally placed
tumors involving the
main bronchus of
those that straddle the
fissure
Complication of lung resection
Bleeding
Respiratory infection
Persistent air leak
Bronchopleural fistula