Trial Short Case 2 April 2024

Case Summary

CASE SUMMARY

A 66-year-old fit and well female has been referred to you for surgical resection of a right hilar mass. She had presented with dyspnoea

Past medical history includes:

Active smoker (40 pack years)

Hepatitis C (secondary to blood transfusion, treated with Interferon)

Excision of melanoma from nose/temple region


The follow investigations were performed:

CT chest:

- Right superior hilar mass  3 x 3 x 1.8cm, no endobronchial component. No left hilar or mediastinal lymphadenopathy

FDG PET scan:

-marked increased uptake in the right hilar mass. No abnormal uptake involving hilar or mediastinal lymph nodes and no distant metastasis seen

EBUS:

-Station 11R node needle washings positive for adenocarcinoma (PDL1 20%, KRAS G12C mutation, ROS1 and ALK negative)

-Right upper lobe bronchial washings negative for malignancy

Questions

  1. Describe the various types of pulmonary resection and the indication(s) of each.

  2. Explain using the segment counting method how you determine predictive post-operative lung function (PPO) for FEV1 and DLCO. What parameters would make you stratify the patient into a low-risk or high-risk category?

  3. Interpret the pulmonary function test. Describe some other forms of exercise testing can assist with further evaluating the operability of this patient.

  4. Explain the role of neoadjuvant therapy. What are the advantages and disadvantages?

  5. Upfront surgery is decided against. After neoadjuvant therapy, the hilar lesion is now smaller and localised around the junction of the right upper lobe bronchus and bronchus intermedius. You decide to perform a right upper sleeve lobectomy given the patient’s pre-operative lung function. Describe the pertinent steps of this operation.