VATS - 1260138

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merryc3
VATS - 1260138

if someone is having a robotic wedge done and the tumor is confirmed malignant, will a lobectomy have to be done or is the surgeon just looking for clear margins? How big a margin is standard?the nodule is 2.2cm....no biopsy will be done before surgery
thank you
merry

catdander
Reply To: VATS

Hi merry, Welcome to Grace.

There's a very good video post done by the distinguished thoracic surgeon, Dr. Eric Vallières. He discusses the aspects of lung cancer surgery including VATS, open thoracotomy as well as lobectomy and wedge resection. It's so packed with information you probably want to take advantage of the transcript and images to decipher all the info. Don't hesitate to ask follow up questions as well.
We need to make sure there aren't any changes in practices, though I just listened to it and I think everything still applies...with the possible exception that more wedge resections are done. Choosing what surgery to preform is still an iffy process and needs to be made by the attending surgeon who has all the info on the patient. http://cancergrace.org/lung/2009/03/06/ev-surgery-for-lung-ca/

Though we can't possibly have a doctor give as much input as the post to which I've linked I will ask as doctor to reply.

I hope all goes well with surgery,
Janine

Dr West
Reply To: VATS

The gold standard is still a lobectomy, especially for a tumor over 1-2 cm. There isn't any clear standard for a margin...it depends on the tumor. A small (less than a cm, for instance), likely very indolent cancer can often do well with a wedge and a small negative margin, but at least a cm is preferred for a more aggressive, invasive cancer.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

merryc3
Reply To: VATS

Thank you for your reply. Do you think chemo will be also necessart if the lobe is taken. That would depend on what?
Thank you again.....

catdander
Reply To: VATS
Dr West
Reply To: VATS

Adjuvant chemotherapy is generally strongly considered/recommended for fit patients with node-positive resected NSCLC and/or a primary tumor 4 cm or larger. For smaller node-negative tumors, in general the risks posed by adjuvant chemo exceed the very marginal anticipated benefit of it, so there is no established benefit for adjuvant chemotherapy in those lower risk cases. However, current recommendations also allow for consideration of chemo for patients who undergo a wedge resection and have incomplete surgical staging, since you can't be as confident that a patient is node-negative if many nodes were left un-sampled by not being taken out at surgery.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education