Perspectives in Lung Cancer

351 Pages·2020·4.753 MB·English

by  Keyvan Moghissi, Jack Kastelik, Philip Barber, Peyman Sardari Nia

Frontiers in Lung Cancer
(Volume 1)
Perspectives in Lung Cancer
Edited by
Keyvan Moghissi
The Yorkshire Laser Centre, Goole, UK
Jack Kastelik
Hull University Teaching Hospitals NHS Trust, Hull,UK
Philip Barber
Manchester University, NHS Foundation Trust, Manchester, UK
&
Peyman Sardari Nia
Maastricht University Medical Center, Maastricht, Netherlands
Frontiers in Lung Cancer
Volume # 1
Perspectives in Lung Cancer
Editors: Keyvan Moghissi, Jack Kastelik, Philip Barber and Peyman Sardari Nia
ISBN (Online): 9789811459566
ISBN (Hardback/Hardcover): 9789811459542
ISBN (Paperback/Softcover): 9789811459559
© 2020, Bentham Books imprint.
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CONTENTS
PREFACE ................................................................................................................................................ i
LIST OF CONTRIBUTORS .................................................................................................................. ii
CHAPTER 1 SURGICAL ANATOMY OF THE CHEST AND LUNG .......................................... 1
Keyvan Moghissi and Peter Tcherveniakov
INTRODUCTION .......................................................................................................................... 1
THORACIC CAGE ........................................................................................................................ 1
MUSCLES OF THE CHEST ........................................................................................................ 2
Trapezius ................................................................................................................................. 3
Latissimus Dorsi ..................................................................................................................... 3
Serratus Anterior ..................................................................................................................... 3
Pectoralis Major ...................................................................................................................... 4
Pectoralis Minor ...................................................................................................................... 4
SKIN AND SUBCUTANEOUS NERVES OF THE THORAX ................................................. 4
THORACIC CAVITY AND PLEURAL SPACE (FIG. 2 AND 3) ............................................ 5
SURGICAL ANATOMY OF THE LUNGS AND BRONCHOPULMONARY SEGMENTS
(FIGS. 4A, 4B, & 4C) ...................................................................................................................... 7
Bronchial Tree (Fig. 4b) ......................................................................................................... 9
Anatomical Aspect ........................................................................................................ 9
Endoscopic Aspect (Bronchoscopy) (Fig. 4c) ............................................................... 10
THORACOSCOPIC ANATOMY OF THE THORACIC CAVITY ......................................... 12
APPROACH TO A VATS ANATOMICAL LUNG RESECTION ........................................... 14
Left Upper Lobectomy ............................................................................................................ 16
Left Lower Lobectomy ........................................................................................................... 17
Right Upper Lobectomy ......................................................................................................... 17
Right Middle Lobectomy ........................................................................................................ 18
Left Upper Lobe Trisegmentectomy ....................................................................................... 18
Lingulectomy .......................................................................................................................... 18
Superior Segmentectomy ........................................................................................................ 19
Basilar Segmentectomy .......................................................................................................... 19
CONCLUSION ............................................................................................................................... 19
CONSENT FOR PUBLICATION ................................................................................................ 20
CONFLICT OF INTEREST ......................................................................................................... 20
ACKNOWLEDGEMENTS ........................................................................................................... 20
REFERENCES ............................................................................................................................... 20
CHAPTER 2 BIOLOGY AND MOLECULAR EVOLUTION OF LUNG CANCER ................... 21
Sean B. Knight
INTRODUCTION .......................................................................................................................... 21
THE LUNG MICROENVIRONMENT ....................................................................................... 22
DNA MUTATIONS AND MALIGNANT TRANSFORMATION ............................................ 22
LUNG CANCER CELLS OF ORIGIN ........................................................................................ 26
EVOLUTION FROM DRIVER MUTATION TO MALIGNANCY ........................................ 28
THE IMMUNE SYSTEM AND CANCER EVOLUTION ......................................................... 30
TRACKING EVOLUTION OF CANCERS ................................................................................ 33
BIOLOGY OF TUMOUR GROWTH AND METASTASES .................................................... 34
CONCLUSION ............................................................................................................................... 37
CONSENT FOR PUBLICATION ................................................................................................ 37
CONFLICT OF INTEREST ......................................................................................................... 38
ACKNOWLEDGEMENTS ........................................................................................................... 38
REFERENCES ............................................................................................................................... 38
CHAPTER 3 POPULATION SCREENING FOR LUNG CANCER .............................................. 45
Philip Barber
INTRODUCTION .......................................................................................................................... 45
MOLECULAR BIOLOGY ............................................................................................................ 46
EXHALED-AIR, BLOOD, AND SPUTUM ANALYSIS ............................................................ 47
FLUORESCENCE BRONCHOSCOPY ...................................................................................... 47
IMAGING ....................................................................................................................................... 48
Early Studies ........................................................................................................................... 49
Later Developments ................................................................................................................ 50
NLST and Beyond .................................................................................................................. 51
The Refinement of Risk Prediction ......................................................................................... 53
The Manchester Implementation Pilot [59] ............................................................................ 53
CONCLUSION ............................................................................................................................... 57
CONSENT FOR PUBLICATION ................................................................................................ 58
CONFLICT OF INTEREST ......................................................................................................... 58
ACKNOWLEDGEMENTS ........................................................................................................... 58
REFERENCES ............................................................................................................................... 59
CHAPTER 4 IMAGING FOR LUNG CANCER ............................................................................... 63
Gerard Avery and Keyvan Moghissi
SECTION 1 CURRENT PRACTICE AND FUTURE DIRECTION OF THORACIC
IMAGING ....................................................................................................................................... 63
DIAGNOSIS/STAGING ................................................................................................................ 63
Chest Radiography .................................................................................................................. 63
Computed Tomography .......................................................................................................... 65
Pulmonary Nodule ........................................................................................................ 67
Staging ........................................................................................................................... 69
CT Prognostic Information ........................................................................................... 70
Positron Emission Tomography – Computed Tomography [PET -CT] ................................. 70
Radio-Isotope Imaging .................................................................................................. 73
Magnetic Resonance Imaging (MRI) ...................................................................................... 74
Ultrasound ............................................................................................................................... 74
ASSESSMENT OF METASTATIC DISEASE ........................................................................... 75
ASSESSMENT OF TREATMENT RESPONSE ........................................................................ 75
POTENTIAL FUTURE TECHNIQUES/AGENTS .................................................................... 76
SECTION 2 ..................................................................................................................................... 77
FLUORESCENCE AND FLUORESCENCE IMAGING FOR LUNG CANCER .................. 77
Definition ................................................................................................................................ 77
CONSENT FOR PUBLICATION ................................................................................................ 80
CONFLICT OF INTEREST ......................................................................................................... 80
ACKNOWLEDGEMENTS ........................................................................................................... 81
REFERENCES (SECTION 1) ....................................................................................................... 81
REFERENCES (SECTION 2) ....................................................................................................... 84
CHAPTER 5 DIAGNOSTIC APPROACH TO LUNG CANCER ................................................... 85
Jack Kastelik
INTRODUCTION .......................................................................................................................... 85
SYMPTOMS ................................................................................................................................... 86
INITIAL INVESTIGATIONS ....................................................................................................... 87
Fitness Assessment ................................................................................................................. 90
Staging of Lung Cancer .......................................................................................................... 93
Tumour Size Staging ..................................................................................................... 93
Regional Lymph Node Staging ...................................................................................... 94
Lymph Node Stations ..................................................................................................... 94
Metastatic Disease Staging ........................................................................................... 94
Visceral Pleural Invasion ........................................................................................................ 95
Pulmonary Nodules and Early Detection of Lung Cancer ...................................................... 95
Investigations of Peripheral Lesions ....................................................................................... 96
Potentially Resectable N2 Disease .......................................................................................... 97
Pleural Effusion in Lung Cancer ............................................................................................. 98
Imaging ................................................................................................................................... 99
Medical Thoracoscopy ............................................................................................................ 101
Pleurodesis .............................................................................................................................. 102
Indwelling Pleural Catheters ................................................................................................... 104
INVESTIGATIONAL PATHWAY .............................................................................................. 105
CONCLUSION ............................................................................................................................... 106
CONSENT FOR PUBLICATION ................................................................................................ 106
CONFLICT OF INTEREST ......................................................................................................... 106
ACKNOWLEDGEMENTS ........................................................................................................... 106
REFERENCES ............................................................................................................................... 106
CHAPTER 6 BRONCHOSCOPY: DIAGNOSTIC & THERAPEUTIC ......................................... 114
Keyvan Moghissi and Jack Kastelik
BRONCHOSCOPY ........................................................................................................................ 114
DIAGNOSTIC BRONCHOSCOPY ............................................................................................. 114
Instrumentation ....................................................................................................................... 115
Rigid Bronchoscope (RB) .............................................................................................. 115
Flexible Fibreoptic Bronchoscope (FFB) ..................................................................... 115
Fluorescence Bronchoscopy [5 - 7] ........................................................................................ 116
Endobronchial Ultrasound ...................................................................................................... 116
Indications ..................................................................................................................... 116
Safety ............................................................................................................................. 117
Equipment ..................................................................................................................... 118
Learning Curve ............................................................................................................. 118
Advances in EBUS Technology ..................................................................................... 119
THERAPEUTIC/INTERVENTIONAL BRONCHOSCOPY .................................................... 119
Introduction ............................................................................................................................. 119
Interventional Bronchoscopy (IB), Instrumentation and General Principles .......................... 119
INTERVENTIONAL BRONCHOSCOPY (IB), INSTRUMENTATIONS, GENERAL
PRINCIPLES AND METHODS ................................................................................................... 120
Mechanical Methods ............................................................................................................... 121
Bronchoscopic Clearing of the Airway ......................................................................... 121
Foreign Body (FB) Retrieval ........................................................................................ 121
Bronchial Lavage/Whole Lung Lavage ......................................................................... 121
Thermal Methods .................................................................................................................... 122
Diathermy Assisted Piecemeal Excision of Endobronchial Tumor .............................. 122
Cryotherapy ................................................................................................................... 122
Argon Plasma Coagulator (APC) [25 - 27] .................................................................. 123
Radiofrequency Ablation (RFA) .................................................................................... 123
Lasers (see also Chapter 14: Lasers and Photodynamic Therapy (PDT) in Lung
Cancer) .......................................................................................................................... 124
Brachytherapy (BT) [34 - 36] ....................................................................................... 126
Photodynamic Therapy (PDT) ...................................................................................... 127
Stents ............................................................................................................................. 130
CONCLUSION ............................................................................................................................... 131
FURTHER READING ................................................................................................................... 132
CONSENT FOR PUBLICATION ................................................................................................ 132
CONFLICT OF INTEREST ......................................................................................................... 132
ACKNOWLEDGEMENTS ........................................................................................................... 133
REFERENCES ............................................................................................................................... 133
CHAPTER 7 THREE-DIMENSIONAL RECONSTRUCTION AND PRINTING IN SURGICAL
TREATMENT OF LUNG CANCER .................................................................................................... 137
Samuel Heuts and Peyman Sardari Nia
INTRODUCTION .......................................................................................................................... 137
PLANNING OF MINIMALLY INVASIVE LUNG SURGERY ............................................... 139
Conventional Methods ............................................................................................................ 139
Chest X-ray .................................................................................................................... 139
Computed Tomography ................................................................................................. 139
Three-dimensional Anatomical Reconstructions .................................................................... 140
Imaging Modalities ....................................................................................................... 140
Three-dimensional Reconstruction Principal ............................................................... 140
3D Anatomical Reconstructions in Surgical Planning ................................................. 141
Three-dimensional Printing .................................................................................................... 144
Printing Process ............................................................................................................ 144
Three-dimensional Printing in Surgical Planning ........................................................ 145
Pre-operative Planning Specified to Robotic Lung Surgery ................................................... 146
FUTURE PERSPECTIVES ........................................................................................................... 146
CONCLUSION ............................................................................................................................... 147
CONSENT FOR PUBLICATION ................................................................................................ 147
CONFLICT OF INTEREST ......................................................................................................... 147
ACKNOWLEDGEMENTS ........................................................................................................... 148
REFERENCES ............................................................................................................................... 148
CHAPTER 8 THORACIC INCISIONS – SURGICAL ACCESS TO THE THORACIC CAVITY
FOR OPERATIONS ON THE LUNG .................................................................................................. 152
Keyvan Moghissi
GENERAL PRINCIPLES OF THE SURGICAL INCISION AND ACCESS TO THE
THORACIC CAVITY .................................................................................................................... 152
STANDARD POSTEROLATERAL THORACOTOMY TECHNIQUE (FIG. 1) .................. 153
THORACOTOMY – PRONE POSITION (OVERHOLT AND SELLORS-BROWN
POSITION) ..................................................................................................................................... 154
ANTERO-LATERAL THORACOTOMY (FIG. 3) .................................................................... 156
ANTERIOR THORACOTOMY (FIG. 4) .................................................................................... 156
Anterior Thoracotomy with Trans-sternal Extension ............................................................. 157
MEDIAN STERNOTOMY (FIG. 5) ............................................................................................. 157
TRANS-STERNAL BILATERAL THORACOTOMY (FIG. 6) ............................................... 158
Syn Clamshell Thoracotomy/Transverse Sternotomy ............................................................ 158
EXTENDED ANTERO-LATERAL THORACOTOMY (HEMI-CLAMSHELL - TRAP
DOOR INCISION) (FIG. 7) ........................................................................................................... 159
Modifications of Antero-lateral Thoracotomy ........................................................................ 160
Anterior-Cervico – Thoracic ................................................................................................... 160
LIMITED AND MUSCLE SPARING THORACOTOMIES .................................................... 161
Introduction ............................................................................................................................. 161
Limited/postero-lateral (Para Scapular) Thoracotomy ............................................... 161
Axillary and Sub-axillary Thoracotomies .................................................................... 162
Advantages/Disadvantages of Muscle Sparing Thoracotomies .............................................. 163
Advantages of Muscle Sparing Thoracotomies ............................................................. 163
Disadvantages of Muscle Sparing Thoracotomies ....................................................... 163
INCISIONS AND APPROACHES FOR MINIMALLY INVASIVE (MINIMAL ACCESS)
SURGERY; VIDEO ASSISTED THORACIC SURGERY (VATS) ......................................... 163
VATS INCISIONS AND PORTS .................................................................................................. 164
MINIMIZATION OF MINIMAL ACCESS INCISIONS AND PORTS .................................. 166
CONCLUSION ............................................................................................................................... 167
NOTES ............................................................................................................................................. 167
CONSENT FOR PUBLICATION ................................................................................................ 168
CONFLICT OF INTEREST ......................................................................................................... 168
ACKNOWLEDGEMENTS ........................................................................................................... 168
FURTHER READING ................................................................................................................... 168
CHAPTER 9 PRINCIPLE OF STANDARD (CONVENTIONAL) PULMONARY RESECTION
FOR LUNG CANCER ............................................................................................................................ 171
Keyvan Moghissi
INTRODUCTION .......................................................................................................................... 172
DISSECTION AND LIGATION OF VESSELS ......................................................................... 173
BRONCHIAL CLOSURE ............................................................................................................. 174
Additional Tips on Pulmonary Resection ............................................................................... 175
BRONCHO PLASTIC PROCEDURES ....................................................................................... 175
Main Stem Bronchial Excision without Pulmonary Resection ............................................... 176
Bronchoplastic Procedures with Conservation Lung Resection ............................................. 176
Right Upper Lobectomy with Sleeve Bronchial Resection (Fig. 1) .............................. 176
Left Upper Lobectomy Sleeve Resection ....................................................................... 177
Other Broncho Plastic Procedures ............................................................................... 178
Excision of the Carina, Right and Left Main-Stem Bronchi (Bifurcation Resection) -
Followed by Reconstruction of the Air Way .......................................................................... 178
Circuit A ........................................................................................................................ 181
Circuit B ........................................................................................................................ 181
Tracheal Sleeve Pneumonectomy (Synonym Carinal Pneumonectomy) for Lung Cancer
Extending to the Latera Wall of the Trachea .......................................................................... 182
Pancoast Tumours (Synonym Superior Sulcus Tumour) ........................................................ 188
Lung Cancer Invading the Chest Wall .................................................................................... 190
CONCLUSION ............................................................................................................................... 193
FURTHER READING ................................................................................................................... 193
Further Reading for Bronchoplastic Operation ....................................................................... 193
Further Reading for Tracheal Sleeve Pneumonectomy .......................................................... 195
Further Reading for Lung Cancer Invading the Chest Wall ................................................... 195
CONSENT FOR PUBLICATION ................................................................................................ 196
CONFLICT OF INTEREST ......................................................................................................... 196
ACKNOWLEDGEMENTS ........................................................................................................... 196
REFERENCES FOR TSP .............................................................................................................. 196
REFERENCES FOR PANCOAST TUMOUR ............................................................................ 196
CHAPTER 10 VIDEO-ASSISTED THORACOSCOPIC SURGERY ............................................ 198
Mahmoud Loubani and Marcello Migliore