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BTOG 2026 | The role of surgery in resectable or oligometastatic thoracic malignancies
Aman Coonar, MBBS, MD, MRCP, FRCS, Royal Papworth Hospital, Cambridge, UK, describes the concept of borderline cases in the context of thoracic surgery, specifically in terms of operability and resectability, as well as oligometastatic disease. Individualized care is important in this setting, where surgery has a significant role in disease control and improving quality of life, and advancements in perioperative management have expanded the possibilities for operating on patients with poorer lung function. This interview took place at the 2026 British Thoracic Oncology Group (BTOG) congress in Edinburgh, UK.
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Transcript
I’m going to actually answer that in two ways. Borderline in terms of their operability, meaning their fitness for surgery, and borderline in terms of their resectability, in terms of can we get the disease out? And actually, is it appropriate in the context of oligometastatic disease? So first of all, let’s deal with the last one first. Oligometastatic disease should be treated on its merits so what we’re talking about is disease control we’re talking about developing a situation in which the patient can live with their disease long term with good quality of life so it’s very much about individualized care and definitely surgery has got an important role in that and indeed we you know if you’ve got metastases that have got, that appear to be controllable with surgery, then certainly that’s a very, very good option...
I’m going to actually answer that in two ways. Borderline in terms of their operability, meaning their fitness for surgery, and borderline in terms of their resectability, in terms of can we get the disease out? And actually, is it appropriate in the context of oligometastatic disease? So first of all, let’s deal with the last one first. Oligometastatic disease should be treated on its merits so what we’re talking about is disease control we’re talking about developing a situation in which the patient can live with their disease long term with good quality of life so it’s very much about individualized care and definitely surgery has got an important role in that and indeed we you know if you’ve got metastases that have got, that appear to be controllable with surgery, then certainly that’s a very, very good option. Now, what about borderline operability? I think that one of the things we’ve really learned, and this comes from our work with lung volume reduction and the very frail patient, is that a lot of that frailty can be reversed and also we can actually operate on people who’ve got much worse lung function than we used to think that were the limits. So in that group, I think that there’s a big opportunity to operate more with very good outcomes because we got a lot better at managing those patients in the perioperative period. And then in terms of borderline resectability, I think that surgeons are developing their techniques. But I think it is really important that that should be a surgical decision about what they can achieve in their particular unit. So in some units, there are more resources. They may also be a transplant unit they may have on-site cardiac surgery and other units may not have those facilities so I think it has to be tailored for the patient the surgeon and the unit and also the other thing I’d emphasize is that thoracic surgery is very collaborative so we would encourage thoracic surgeons if they think it may be possible to treat a patient in another unit to encourage a second opinion we welcome that
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