Interview with Gunwoo,Kim, professor of lung cancer center at Gachon University Gil Medical Center

Lung cancer is the cancer with the highest death rate. According to the National Cancer information Center, the number of deaths  from lung cancer last year was 22.9% of all cancer patients.

(18,574people) were overwhelmingly higher than liver cancer(13%),colon cancer(11%)and stomach cancer(9.4%). Lung cancer penetrates silently.  If a patient feel abnormal symptoms, it should be more than over 3rd stage already. Fortunately, lung cancer was added to the national cancer screening project last year, raising the rate of early detection that was noticed when it was "small lung cancer". And also since the method of surgery have developed,patients'burden on surgery has been reduced. we interviewed professor Gun-woo,Kim(42,Thoracic surgery department) at Gachon university Gil Medical Center and heard about the importance of lung cancer surgery and diversified surgery methods.

Q : Surgery is the most effective method of treatment.
Yes, it is. Surgery is the way to clean up the lungs of the cancerous area. Unlike the liver, the lung does not regenerate once it is cut off. As much as it is lost, and it loses its function. For this reason, the long-term survival rate and recurrence rate of lung cancer patients are calculated in advance to determine the extent to be cut. The lungs consists of 5 lobes, each having a total of 18sections(lobes). There are several large and small partitions in the barrel. Until now, the principled surgical treatment of lung cancer is a method of resection of lobes and lymphatic vessels in the lungs. Lymphatic vessel can be a pathway for cancer cells, thus they are restrained. In general lung cancer surgery, one or two lbes are usually resected and the remaining lobes maintain lung function. In some patients, however, they do not take out the entire lobe, but only cut out a few areas that are part of the lobe and perform zoning to preserve the lungs as much as possible.
 
Q : What patients are recipient for segmentectomy.
The targets include lung cancer, which is very small in size or has low levels of malignancy, such as liver glass shading and patients with impaired lung function. Among them, liver glass shading is low in malignancy and has a good prognosis to the extent that even a small amount of lung is expected to heal completely so a patient can consider segmentectomy instead of resectioning the lobe. For patients whose lung function has deteriorated due to underlying diseases such as chronic closed lung disease(COPD) and pulmonary fibrosis, it may be advantageous to resect only the area rather than the lobe of the lungs. However, cutting out fewer lungs does not necessarliy mean that it is good. This is because there is a possibility that cancer may remain. In fact, it is reported that the recurrence rate of local lung cancer is a little higher than that of lobe after performing segmentectomy.

Q : What are the standard of lung that possible for lung surgery.
"After cutting the lung, predicting the function of the remaining lung before surgery to determine whether it is possible to operate and a typical method is to calculate it as a "lung zone."  For exmaple, if all the upper right lobe of the lung is resected, three of the 18areas of the lung will be lost. As a result, 15 out of 18 lungs remain after surgery, after 83% of the total. The figures from these calculation can be assumed to be 'predictable lung function after surgery'. If the figure is more than 60%, it can be considered "safe to operate," and if it is less than 30%, it can be "difficult to operate." At mid-range 30~60percent, patients can try surgery after maximising lung function with lung rehabilitation program such as preoperative aerobic exercise.

Q : Who is possible to go on thoracic endoscopic surgery.
"The guidelines for thoracic endoscopic surgery are to be conducted only when lung cancer is less than 3cm, the first and second stages of the surgery, and if lung cancer has not spread to the lymphatic vessels. The rest are subject to thoracic surgery. Recently, however, the scope of chest endoscopic surgery is expanding. In fact, many reports say that the results of the surgery were better after conducting chest endoscopy on patients other than those recommended for guidelines. Lung cancer spreads well to the brain, bones, and adrenal, and in the case of Gachon University Gil Hospital's lung center, it is receiving positive treatment by combining chest endoscopy and anti-cancer treatment for 4th stages of patients whose lung cancer has spread to one or two other organs. This is remarkable achievement cmpared to the fact that only anti-cancer treatments were available in the past, Gachon University Gil Hospital Center has conducted 93% of all lung cancer surgeries this year with chest endoscopy.

Q : What are the advanced technique of surgery type for lung cancer.
"There are mainly 4 types. Firstly, lung cancer that is being reoccured. This is a case of recurrence of lung cancer or new cancer in other parts of the lungs. This is due to the 'adhession phenomenon in which tissues stick together. THe surgery can be carried out only when the tissue attached to the existing surgical site is well seperated. Secondary,lung cancer has invaded the chest wall. The chest wall is a thick layer, and the chest wall cut during surgery must be replaced with an artificial structure. Thirdly, lung cancer has invaded the bronchial tubes. part of the bronchial tubes should be cut off and the remaining bronchial tubes should be connected together. Fourthly, lung cancer invaded into the heart. A cardiophoric surgeon in charge of each heart and lung will be deployed to use by using a cadiopulmonary arrester. Everyone needs high level of techniques. If a patient have a complicated lung cancer lesion, we recommend a patient to check carefully to see if your doctor has a lot of clinical experiences.

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