Question 1

Q: A 65-year-old man with severe COPD (FEV1 35% predicted) presents with a 4 cm right upper lobe mass. Biopsy confirms squamous cell carcinoma. PET scan shows no distant metastases or mediastinal lymph node involvement. Pulmonary function tests show marginal lung function. Apply the appropriate surgical management strategy for this patient.

Wedge resection or segmentectomy with lung-sparing approach. ***Wedge resection or segmentectomy with lung-sparing approach*** - In patients with **marginal pulmonary function** (FEV1 < 40%), **sublobar resection** is indicated to minimize the loss of functional lung tissue and reduce postoperative morbidity. - While lobectomy is standard, a lung-sparing approach balances **oncologic control** with the patient's severe **respiratory limitations**. *Stereotactic body radiation therapy only* - **SBRT** is typically reserved for patients who are medically **inoperable**; however, this patient may still tolerate a localized surgical approach. - Surgery remains the **gold standard** for definitive local control in Early-stage Non-Small Cell Lung Cancer (NSCLC) if physiologically feasible. *Neoadjuvant chemotherapy followed by lobectomy* - There is no evidence of **mediastinal lymph node involvement** or advanced disease on PET scan, making neoadjuvant therapy unnecessary for this stage. - A **lobectomy** in a patient with a baseline FEV1 of 35% carries a prohibitively high risk of postoperative **respiratory failure**. *Standard right upper lobectomy via thoracotomy* - Standard **lobectomy** is the treatment of choice for patients with good pulmonary reserve, but it is contraindicated here due to **low FEV1**. - High-risk patients undergoing lobectomy often succumb to **pulmonary complications** and have significant long-term disability. *Pneumonectomy to ensure complete resection* - **Pneumonectomy** involves removing an entire lung, which is impossible for a patient with **Stage III/IV COPD** and limited reserve. - This procedure carries the highest **mortality and morbidity** and is excessive for a localized 4 cm peripheral mass.

Question

A 65-year-old man with severe COPD (FEV1 35% predicted) presents with a 4 cm right upper lobe mass. Biopsy confirms squamous cell carcinoma. PET scan shows no distant metastases or mediastinal lymph node involvement. Pulmonary function tests show marginal lung function. Apply the appropriate surgical management strategy for this patient.

Accepted Answer

Wedge resection or segmentectomy with lung-sparing approach

Answer

Stereotactic body radiation therapy only

Answer

Neoadjuvant chemotherapy followed by lobectomy

Answer

Standard right upper lobectomy via thoracotomy

Answer

Pneumonectomy to ensure complete resection

Cardiothoracic Surgery — MCQs

Cardiothoracic Surgery — MCQs

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