eMedicine Specialties > Thoracic Surgery > Tumors

Benign Lung Tumors: Treatment

Author: Dale K Mueller, MD, Associate Professor of Surgery, Section Chief, Department of Surgery, University of Illinois at Peoria; Co-Medical Director, Thoracic Center of Excellence, Vice-Chair, Department of Cardiovascular Medicine and Surgery, OSF St Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, SC
Coauthor(s): Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center; Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Contributor Information and Disclosures

Updated: Jun 11, 2009

Treatment

Medical Therapy

A solitary nodule in a young nonsmoking patient can be monitored with serial radiographs as long as the solitary nodule does not double in size in less than a year and it does not significantly increase in the pattern of calcification and shape consistent with a malignancy. Otherwise, medical therapy is limited to the initial management of complications and associated comorbidity.

Surgical Therapy

The extent of surgery may be simple endoscopic resection, thoracotomy with bronchotomy/local excision, segmental resection, lobectomy, sleeve resection, or pneumonectomy. The extent is usually determined at surgery and is as conservative as possible. Endoscopic resection using the rigid bronchoscope is readily used to resect endobronchial benign lung tumors except for bronchial adenomas. Recently, bronchoscopic resection offers an alternative to surgical resection. At 1 and 10 years, respectively, 100% and 94% of completely resected carcinoids were free of disease. Commonly, surgical resection is recommended for bronchial adenomas because of the potential for malignancy. The surgical approach should include complete resection, sparing of as much lung as possible, and lymph node dissection. Endoscopic resection with neodymium:yttrium-aluminum-garnet (Nd:YAG) laser can be used for adenoma in high-risk or elderly patients.

Preoperative Details

Determine operability and resectability and take steps to prevent or limit operative and postoperative complications.

Intraoperative Details

Anesthesia preparation is similar to that for any standard thoracotomy and involves use of an epidural, double lumen endotracheal tube, and invasive lines (including radial artery catheter and central line). Prior to double lumen placement, bronchoscopy via a standard endotracheal tube should identify any endobronchial component and plan for the surgical resection. At the time of open thoracotomy, perform a complete tumor resection and conserve as much lung as possible. In the setting of a lung adenoma, a complete lymph node dissection should also be performed.

Postoperative Details

Triage the patient to the surgical ICU or postoperative recovery floor.

Follow-up

When observation is elected as medical management, performing chest radiograph surveillance every 3 months for the first year, every 6 months the second year, and yearly thereafter is recommended.

For excellent patient education resources, visit eMedicine's Procedures Center and Cancer and Tumors Center. Also, see eMedicine's patient education article Bronchoscopy and Bronchial Adenoma.

Complications

Possible complications due to benign lung tumors include pneumonia, atelectasis, hemoptysis, hyperinflation, and malignancy.

More on Benign Lung Tumors

Overview: Benign Lung Tumors
Workup: Benign Lung Tumors
Treatment: Benign Lung Tumors
Follow-up: Benign Lung Tumors
References
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References

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Further Reading

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Keywords

lung tumor, lung tumors, benign lung tumor, benign lung neoplasms, lung cancer, lung lesion, pulmonary nodules, primary lung tumors, neoplastic lesions, pneumonia, atelectasis, hemoptysis, hamartomas, bronchial adenomas, chondroadenomas, bronchial cystadenomas, mucous gland adenomas, tracheobronchial tumors, parenchymal tumors, sclerosing hemangioma, lung treatment

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Contributor Information and Disclosures

Author

Dale K Mueller, MD, Associate Professor of Surgery, Section Chief, Department of Surgery, University of Illinois at Peoria; Co-Medical Director, Thoracic Center of Excellence, Vice-Chair, Department of Cardiovascular Medicine and Surgery, OSF St Francis Medical Center; Cardiovascular and Thoracic Surgeon, HeartCare Midwest, SC
Dale K Mueller, MD is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, American Medical Association, American Medical Writers Association, Chicago Medical Society, Illinois State Medical Society, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center
Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Oluyinka S Adediji, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Richard Thurer, MD, B and Donald Carlin Professor of Thoracic Surgical Oncology, Miller School of Medicine, University of Miami
Richard Thurer, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Medical Association, American Thoracic Society, Florida Medical Association, Society of Surgical Oncology, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Daniel S Schwartz, MD, FACS, Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital
Daniel S Schwartz, MD, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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