1. Lung cancer continues to be a highly lethal and extremely
common cancer, with 5-year survival of 15%. Lung cancer
incidence is second only to the incidence of prostate cancer in
men and breast cancer in women. Squamous cell carcinoma and adenocarcinoma
of the lung are the most common subtypes and are rarely found in
the absence of a smoking history. Nonsmokers who live with smokers have
a 24% increased risk of lung cancer compared to nonsmokers
who do not live with smokers.
2. Endoscopic bronchial ultrasound is a valuable new tool that can
enhance the accuracy and safety of transbronchial biopsies of both
the primary tumor (when it abuts the central airways) and the mediastinal
lymph nodes and should become part of the surgeon’s armamentarium
for the diagnosis and treatment of lung cancer.
3. The assessment of patient risk before thoracic resection is based
on clinical judgment and data.
4. Impaired exchange of carbon monoxide is associated with a significant
increase in the risk of postoperative pulmonary complications, independent
of the patient’s smoking history. In patients undergoing pulmonary
resection, the risk of any pulmonary complication increases by 42% for
every 10% decline in the percent carbon monoxide diffusion
capacity (%Dlco), and this measure may be
a useful parameter in risk stratification of patients for surgery.
5. Maximum oxygen consumption (V̇o2max)
values provide important additional information in those patients
with severely impaired Dlco and forced expiratory
volume in 1 second. Values of <10 mL/kg per minute generally
prohibit any major pulmonary resection, because the mortality in
patients with these levels is 26% compared with only 8.3% in
patients whose V̇o2max is ⩾10 mL/kg
per minute; values of >15 mL/kg per minute generally indicate
the patient’s ability to tolerate pneumonectomy.
6. Major changes in the tumor, node, and metastasis (TNM) staging
system for lung cancer have been proposed. Tumor stage will be further
subdivided into T1a and T1b, T2a and T2b, T3, and T4. Satellite nodules
in the same lobe will be considered T3 and malignant pleural and
pericardial effusions will be considered metastatic disease rather
than T4 disease.
7. Increasing evidence suggests a significant role for gastroesophageal
reflux disease in the pathogenesis of chronic lung diseases such
as bronchiectasis and idiopathic pulmonary fibrosis, and it may
also contribute to bronchiolitis obliterans syndrome in lung transplant
8. Multidrug-resistant tuberculosis (MDRTB) organisms are present
in approximately 10% of new tuberculosis cases and 40% of
recurrent cases. Another rare disease variant termed extensively
drug-resistant tuberculosis has also been identified. The
causative organisms are resistant not only to isoniazid and rifampin,
as are the MDRTB organisms, but also to at least one of the injectable
second-line drugs such as capreomycin, amikacin, and kanamycin.
9. Treatment of pulmonary aspergilloma is individualized. Asymptomatic
patients can be observed without any additional therapy. Similarly,
mild hemoptysis, which is not life-threatening, can be managed with
medical therapy, including antifungals and cough suppressant. Amphotericin
B is the drug of choice, although voriconazole ...