Lung cancer

Only 10% of lung tumours are surgically resected because the disease presents late as there is no suitable test for screening (Table 3.77.1). Complete surgical resection is most effective for peripheral tumours away from the hilum, most commonly for stage I or II non-small cell lung cancer. Incomplete resection may palliate symptoms or ‘down-size’ the tumour for better response to adjuvant chemotherapy or radiotherapy.

Table 3.77.1 Types of Lung Cancer^a

Resectable tumours can be identified with plain radiograph, CT, positron emission tomography (PET) with rigid or flexible bronchoscopy but overall health state of the patient (operability) must be considered. Lung resections usually involve removal of an entire lung (pneumectomy), lobe (lobectomy), bronchopulmonary segment (segmentectomy) or a wedge resection. Surgery is performed through a thoracotomy or, less invasively, thoracoscopically when technically feasible.

Empyema

An empyema is a collection of pus in the pleural space and may be life threatening. A preceding pneumonia, a swinging fever and weight loss may be present. Empyema is a potential complication of chest drains. Established empyemas should undergo a prompt decortication procedure via a thoracotomy (the infection is drained and the pleural layers freed), with perioperative intravenous antibiotic therapy.

Rib fractures and flail chest

A double fracture, usually caused by a compression force, results in a floating section of the rib (flail segment; Fig. 3.77.1), which may damage underlying contents and cause paradoxical respiration. Treatment depends upon the severity of the injury:

simple rib fracture: analgesia and physiotherapy