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BTOG 2026 | How will the role of surgery in thoracic oncology evolve over this decade?
Aman Coonar, MBBS, MD, MRCP, FRCS, Royal Papworth Hospital, Cambridge, UK, comments on the evolving role of surgery in thoracic oncology, noting that while surgery will remain central, it will become more complex due to the effects of preoperative treatments on patient anatomy. Despite these challenges, minimally invasive approaches will still be feasible for most cases, with surgeons adapting to achieve low complication rates and preserved outcomes. This interview took place at the 2026 British Thoracic Oncology Group (BTOG) congress in Edinburgh, UK.
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Transcript
Actually I think surgery will stay absolutely central in that and I think there’ll be expanded numbers of patients needing surgery. The surgery will change, it’ll be more complex. These patients do face the impact of what has happened inside their chest with the medications that they’ve been given, the treatments they’ve been given. So quite often we’ll find that nodal disease will have involuted onto the pulmonary arteries, which can be more difficult to dissect off...
Actually I think surgery will stay absolutely central in that and I think there’ll be expanded numbers of patients needing surgery. The surgery will change, it’ll be more complex. These patients do face the impact of what has happened inside their chest with the medications that they’ve been given, the treatments they’ve been given. So quite often we’ll find that nodal disease will have involuted onto the pulmonary arteries, which can be more difficult to dissect off. But having said that, I still think the majority of those cases will still be done minimally invasively. And I think patient outcomes, certainly we’re seeing that surgeons are learning how to deal with that situation very well. And it appears that there’s a low complication rate with preserved outcomes. So I think it will stay very central. Something else I think we need to consider is that currently people go down a perioperative chemo-immunotherapy plus surgery pathway if they are initially thought to be resectable. And I think that what we think of as resectable has to change. And I think that we will increasingly be offering anybody who’s got just locoregional, so not metastatic disease, chemo-immunotherapy and then assessing their response and then deciding whether or not they are resectable or whether they need to go down a radiotherapy pathway.
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