Lung Cancer
It is a significant health issue in worldwide.
1.Increasing Rate:
Lung cancer incidence has been on the rise in India due to factors like urbanization, industrialization, and lifestyle changes.
2.High Mortality:
- It is among the leading causes of cancer-related deaths in India, particularly among men.
3.Gender Disparity:
- Lung cancer is more common among men than women in India, largely due to higher rates of tobacco smoking among men.
Risk Factors
1.Tobacco Smoking:
- The primary risk factor for lung cancer worldwide and in India. Both active and passive smoking increase the risk significantly.
2.Air Pollution:
- India’s high levels of air pollution, particularly in urban areas, contribute to lung cancer risk. Exposure to pollutants like particulate matter, sulfur dioxide, and nitrogen dioxide is linked to the disease.
3.Occupational Hazards:
- Exposure to carcinogens such as asbestos, arsenic, radon, and certain industrial chemicals in workplaces increases the risk of lung cancer.
4.Indoor Air Pollution:
Cooking and heating with solid fuels like wood, coal, or biomass in poorly ventilated indoor spaces can expose individuals to carcinogens and increase lung cancer risk.
5.Occupational Hazards:
- Certain genetic predispositions and family history of lung cancer can elevate an individual’s risk.
Types of Lung Cancer
1.Non-Small Cell Lung Cancer (NSCLC)
Adenocarcinoma:
The most common type, often found in non-smokers and women. It tends to develop in the outer parts of the lungs.
Squamous Cell Carcinoma:
- Often linked to smoking and tends to arise in the larger airways of the lungs.
Large Cell Carcinoma:
2. Small Cell Lung Cancer (SCLC)
Typically associated with heavy smoking, grows rapidly, and is more likely to spread to other parts of the body.
Lung cancer diagnosis & Treatment
It typically involves imaging tests like CT scans, PET scans, and biopsies( CT guided or Thoracoscopic).
- Treatment options depend on the stage and type of cancer and it includes surgery, chemotherapy, radiation therapy, immunotherapy, or targeted therapy.
- Surgery remains the one of main treatment option for yearly Lung Cancer.
- It includes removing the tumor only from normal Lung tissue or Lobectomy or in some cases removing the whole Lung (Pneumonectomy).
- Thoracoscopic surgery, also known as video-assisted thoracoscopic surgery (VATS), is a minimally invasive approach that uses small incisions and a tiny camera to guide the surgeon. Compared to traditional open surgery, VATS often results in shorter hospital stays, less pain, and quicker recovery times.
- During VATS, we make small incisions between the ribs and inserts a thoracoscope, allowing us to see inside the chest cavity.This approach can be used for various lung cancer procedures, including lobectomy (removal of a lobe of the lung), wedge resection (removing a small portion of the lung), or lymph node biopsy.
Role of Indocyanine green (ICG) in Thoracoscopic lung surgery
1.Enhanced Visualization
- Perfusion Assessment: ICG is used to assess lung perfusion during surgery. After intravenous injection, ICG binds to plasma proteins and emits fluorescence when illuminated with near-infrared light. This helps surgeons visualize the vascular and perfusion status of lung tissues, ensuring adequate blood supply to the remaining lung after resection.
- Segmental Resection: For segmentectomy, ICG helps delineate the intersegmental plane. By injecting ICG into the pulmonary artery supplying the segment to be preserved, the boundary between the fluorescent and non-fluorescent areas marks the resection plane, allowing precise and limited removal of lung tissue.
2.Tumor Localization
Intraoperative Navigation: Preoperative injection of ICG around the tumor can help localize small or deep-seated lesions that are difficult to palpate or visualize during surgery. This technique enhances the accuracy of tumor resection and helps ensure complete removal of the malignancy.
Identification of Lymph Nodes in Lung Cancer
1.Sentinel Lymph Node Mapping
Detection: ICG is used for sentinel lymph node mapping in lung cancer. By injecting ICG near the tumor or in the pleural space, the lymphatic drainage can be visualized, highlighting sentinel lymph nodes that are the first to receive metastatic cells.
- Guided Biopsy: Fluorescent guidance helps identify and biopsy these sentinel nodes, enabling more accurate staging and potentially reducing the extent of lymph node dissection required.
2. Improved Staging
Accurate Staging: ICG fluorescence helps in the precise identification and biopsy of lymph nodes, leading to more accurate staging of lung cancer. Accurate staging is crucial for determining the appropriate treatment plan and prognosis.
3.Reduced Morbidity
Selective Dissection: By targeting only the fluorescent lymph nodes, surgeons can perform more selective and less extensive lymph node dissections. This reduces surgical morbidity and preserves more normal tissue, improving postoperative recovery and outcomes.
Benefits:
- Non-Radioactive: ICG is a non-radioactive, safe dye with a favorable safety profile. It is generally well-tolerated with a low incidence of allergic reactions.
- Real-Time Imaging: The use of ICG provides real-time feedback during surgery, enhancing the surgeon’s ability to make informed decisions intraoperatively.
- Technological Requirements: The use of ICG requires specialized near-infrared fluorescence imaging systems, which might increase the cost and complexity of the surgical setup.
- Learning Curve: Surgeons need training to interpret fluorescence images correctly and to integrate this technology effectively into their surgical workflow.
Overall, ICG fluorescence imaging represents a significant advancement in thoracoscopic lung surgery and lymph node identification, improving the precision and outcomes of lung cancer surgeries.