I have seen a critically ill patient online. It was consulted by a family member. This 56-year-old patient has mild pulmonary fibrosis, but it is not particularly obvious when doing light physical labor. The chest tightness and asthma, life can be completely self-care. This patient found a 2.5cm nodule in the physical examination a month ago, which was highly suspected of malignancy. The patient had a strong willingness to treat. After a pulmonary function test, he was able to tolerate anesthesia. After a thorough evaluation by the thoracic surgery department, he was given a pulmonary nodule under endoscopy. The resection was successful, and the postoperative pathology confirmed invasive adenocarcinoma, stage IA3. The family members have not had time to share the joy. The patient developed respiratory failure one week after the operation. CT showed that the interstitial pneumonia was significantly aggravated. Despite the hormone shock, the patient was still unable to breathe independently from the ventilator.
Can mild pulmonary fibrosis be treated with lung resection?
A doctor shared a case he encountered on the online platform and matched the patient’s chest CT image. He said: mild pulmonary fibrosis accompanied by lung cancer, thoracic surgeons must not do it Lobectomy, such patients can lead to acute exacerbation of pulmonary fibrosis soon after surgery, and lose the chance of survival in the short term. A wise choice is to do PET-CT before surgery to exclude metastasis and directly choose lung transplantation for evaluation. Lung transplantation can kill two birds with one stone, treating both tumors and pulmonary fibrosis. The patient who came to see a doctor online today had pulmonary fibrosis and aggravated respiratory failure 4 days after lobectomy. He had been intubated for one month and lost the opportunity for transplantation.
I have to say that patients with underlying lung diseases must be cautious when performing lobectomy. The operation itself is only the first step of a long march for the patient. Recovery is the key. People with underlying lung diseases, such as chronic obstructive pulmonary disease and pulmonary fibrosis, even if it is only mild to moderate, but such patients have suffered certain damage to their own lung function, and usually only maintain a tight balance in daily life. Once they experience the trauma of surgery , the balance is broken, the immune system declines rapidly, and various complications will occur after surgery, such as secondary infection, aggravation of interstitial pneumonia, which can be life-threatening at any time, and the respiratory area is reduced after lobectomy, and lung function further declines. After the post-operative recovery period, the quality of life will be greatly reduced in the later period.
So, what is the treatment for early stage lung cancer like this, if not surgery?
In fact, in recent years, the guidelines have made it clear that for patients with early-stage lung cancer who are not suitable for surgery or who are unwilling to undergo surgery, the level I recommendation is stereotactic radiation therapy (SBRT), and various Advanced radiotherapy techniques are also recommended in the guidelines, such as VMAT (Volume Rotation Intensity Modulated Radiation Therapy), IGRT (Image-Guided Radiation Therapy), and proton heavy ion therapy.
In addition to precise stereotactic radiotherapy, radiofrequency ablation can also be used as an alternative treatment for early inoperable lung cancer. Although the cure rate is not as good as surgery and stereotactic radiotherapy, it is also good for elderly patients. choose.