Surgery in lung cancer
In general only 20% of all new cases of non-small cell lung cancer ever go to surgery. The overall 5-year survival after surgery is about 25%.
Absolute contraindications for surgery include:
- patient refusal
- metastases (CT scanning now detects metastases more frequently than a decade ago)
Relative contraindications include:
- the cell type - small cell carcinoma are usually inoperable
- poor respiratory reserve:
- FEV1 > 1.2l is necessary for lobectomy, and > 1.8l for pneumonectomy
- a raised PaCO2 is a contraindication for surgery
- other disease - especially myocardial
- mediastinal involvement
- age - in patients over 70, surgery is usually inadvisable because the benefits are outweighed by operative morbidity and mortality
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