Diseases of the lungs that require surgery

introduction

If classic symptoms of a lung disease such as acute pain in the chest, shortness of breath (dyspnea), reduced performance or even an effusion in the lungs occur - but also if there are incidental findings from preventive examinations or the like - it is always advisable to clarify exactly where The cause of these signs is and whether treatment may be appropriate.

In the case of the lungs, there are many different diseases that can cause a functional disorder or impairment. Some of these are easily treatable or even do not require treatment at all, while others are diseases of the lungs that require surgical treatment and require special interventions. In this group, diseases that should always be treated surgically can be distinguished from those for which an operation is offered in certain situations or as a last resort.

Symptoms

All lung diseases that have to be treated surgically have in common that the ventilation of the lungs is generally impaired or the oxygen exchange within the organ shows a problem.
In most cases this manifests itself in shortness of breath and a significantly reduced performance. The other characters are mostly unspecific and therefore cannot be clearly assigned.

If it is a disease of the lungs that has to be treated surgically, a narrowly circumscribed, clearly definable cause can be found as the reason for the symptoms with the help of imaging procedures (X-ray examination, CT, ...). If it cannot be found or if it cannot be clearly represented and delimited, it may be assumed that the situation is inoperable, which makes an alternative treatment necessary.

Common surgical indications

The diseases of the lungs that have to be treated surgically always include diseases from the large group of neoplasms, i.e. new tissue formation, as well as acute injuries with a risk of bleeding such as occur after accidents.
The new tissue formations include lung carcinoma, in which a small cell can be differentiated from non-small cell and neuroendocrine carcinoma, but also other masses within the lungs (generally: tumor), metastases of a tumor disease located elsewhere, which only emerge as the disease progresses the disease have settled in the lungs and the so-called pleural mesothelioma (malignant tumor of the cells that surround the lungs, which surrounds the lungs in the shape of a jacket and is often associated with asbestos exposure).

The second category - surgery after injury - includes all accidents and traumatic events that are associated with heavy and prolonged bleeding (> 200ml blood loss every hour) and / or cannot be controlled conventionally (= without surgical intervention). For example, large bruises in the lung tissue (lung contusion), tears within the lungs (rupture) and naturally penetrating lung injuries (stab, stick, gunshot wounds, ...) in most cases are diseases of the lungs that have to be treated surgically.

Rare surgical indications

More rare, but not to be neglected, are thoracic operations in the case of one Failure or inadequacy of initial therapy. In the case of fresh fluid that collects in the narrow gap between the lungs and the chest (recurrent Pleural effusion), not sufficiently treatable, narrowly circumscribed Lung tissue adhesions (Bronchiectasis), one despite therapy with Antibiotics not healing Pulmonary tuberculosis as well as one that cannot be treated for a long time or that recurs over and over again purulent cavitation within the lung tissue (recurrent Lung abscess) an operative procedure may be necessary.
The same applies if due repealed attachment forcesthat normally hold the lungs against the chest and thus allow them to develop, a lung collapses and accumulated air occurs outside of a lung (spontaneousPneumothorax) as well as the first time if there are other therapy alternatives than ineffective or in the case of chronic suppuration of the tissue that surrounds the lungs (Pleural empyema).

therapy

At Diseases of the lungsthat have to be treated surgically, the area of ​​operation is already through the disease precisely delimited. So although the scope of the surgical interventions is the same in each case, they are different individual treatment techniques strongly from each other and must of course depending on the case, illness and patient specially adapted become.

Basically you can open operations (Thoracotomy) of the minimally invasive video-assisted thoracoscopy (VATS).

In the open surgery is usually obtained from the lateral chest wall about a a few centimeters long cut Access to the operating area. In some cases, however, there is also one complete opening of the thorax Necessary from the front in the middle in order to be able to see and treat larger areas.
The VATS however, works with one camerathat under anesthesia over a small skin incision between the ribs to the surface of the lungs is pushed and the surgeon is given the appropriate view. A second and possibly a third access can then different instrumentsthat are ultimately worked with into the Field of vision and operation to be brought.

Of course, both types offer certain advantages and special risks. In general, it can be said that minimally invasive procedures are the cosmetically more beautiful results and the patient can recover faster after the operation, as the wounds are smaller, usually less painful and therefore less annoying.
The disadvantage of this procedure, however, lies there: Through smaller incisions and small surgical instruments are also only minor interventions possiblewhich must also take place relatively close to the body surface of the patient. Often times are only a few inches to reach depth. In addition, it is often more difficult for the surgeon to identify the area to be treated clearly visible and judge. Often because of this, one will still be concerned with diseases of the lungs that need to be treated surgically against the minimally invasive and opt for open surgery.

Within this are then again many different surgical courses conceivable: Depending on the clinical picture and condition of the patient, the complete removal of a lung (Pneumectomy), about the Separation of part of the affected lung (Lobectomy) until Removal of several smaller segments of the lung (Segment resection) all variants are possible. For some special cases there are also specialized treatment procedures established, such as the Removal of the skin on top of the lung tissue (Pleurectomy) or that Introducing a special talc powder (Talc) into the cavity between the lungs and chest, which is intended to bond both components (pleurodesis).

It is essential before any procedure detailed lung function testin order to be able to assess whether the patient could survive the corresponding operation and whether he or she would still be able to survive the surgical intervention well-functioning lung tissue is available to supply his body with oxygen. In addition, of course, the question always arises whether an operation still feasible at all is. For example, for Carcinoma or tumor removals several important criteria must be met, which stipulate, among other things, that under no circumstances may both halves of the lungs be detectably diseased and the recognizable foreign bodies must be clearly delimited and therefore easily removable. If one or more of these criteria do not apply, the situation is assumed to be difficult or even no longer operable at all, in which another (non-operative) treatment or even a purely palliative care is displayed.

diagnosis

To Diagnosis and unambiguous determination For diseases of the lungs that have to be treated surgically, there are several, in part complementary, in part overlapping examinations and methods.

This is the first stage in the event of an unclear clinical suspicion of a lung disease Chest x-ray (Thorax), which is by default in two levels recorded from both the front and the side.
Important for closer assessment and differentiation, but also for Operation preparation and planning, are the images of the Computed tomograph (CT). In some cases (e.g. with children or special questions) there is also one Magnetic resonance imaging (MRI) conceivable.
Lung specific on the other hand are the possible invasive diagnostic methods: With the help of a Endoscope the airways down to the individual bronchi (Bronchoscopy) or the lungs as a whole (thoracoscopy, cf.VATS). The great advantage of these examinations is the possibility of one at any time sample (Biopsy) to be able to take suspicious tissue areas, which subsequently pathologically examined and classified and the direct representation of the lungs without distorting projections or complex reconstruction at the computer.
However, these are investigations Cannot be performed without anesthesiawhy this risk increased during such invasive examinations.

If you suspect a infectious disease the lung is always one too microbiological diagnostics initiate. This will be done in the laboratory Culture media with samples of the sputumthat the patient has coughed up, or possibly existing rinsing liquidwhich should flush the bronchi clear. Of course, this also applies to the now rare one Case of pulmonary tuberculosis.

Which Type of examination is ultimately chosen by the Type of suspected illness, the experience of the doctor and, to a certain extent, the Standard guidelines of the relevant hospital dependent. Also the possible forecast or the Treatment intention (cure or relieve pain?) determines the scope of the diagnostic equipment.
Because of this, they are almost always several different diagnostic pathways possible, all of them to one matching result can come. As a rule, a combination of the available options will be used to make the patient's lungs and chest as clear and as precise as possible represent and assess to be able to. Based on this, depending on the diagnosis and type of disease, together with the patient and taking his or her into account Wishes and ideas determine the optimal treatment - with or without surgery.

forecast

The individual prognosis from diseases of the lungs that require surgical treatment, varies greatly. It depends on the exact clinical picture, the general condition of the patient and of the Type of surgery and many other factors.
Generally speaking, it can only be predicted that the course will usually more difficult becomes the more lung tissue removed must become. Patients who have had large parts of their lungs removed are hereafter in her remaining breathing capacity noticeably restricted. Young patients with otherwise normal lung findings can usually compensate for this well.

Ever attacked and weakened However, the more difficult the patient's lungs are to ensure adequate levels Breathing activity and oxygenation of the blood. On top of that, especially with Diseases of the lungsthat have to be treated surgically, unfortunately there are some examples of diseases that can be observed even after an optimally proceeded, successful operation very high tendency to recur, so to form relapses.

Because of this, they are Survival rates of these patients calculated over five years very low. All in all, operations of the lungs, as well as diseases of the lungs in general, always involve relatively high riskas the lungs of man indispensable and permanently irreplaceable Organ is. In addition, in almost every procedure in this sensitive area, the Risk of serious complications with sometimes life-threatening consequences, which is why special attention should be paid to additional, controllable risk factors.