ESMO 2022 | The challenges associated with surgery for NSCLC
Jonathan Spicer, MD, PhD, McGill University Health Centre, Montreal, Canada, discusses the challenges associated with surgery for non-small cell lung cancer (NSCLC), including surgery being a patient-specific decision and the physiology of the patient. This interview took place at the European Society for Medical Oncology (ESMO) 2022 Congress in Paris, France.
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Transcript (edited for clarity)
It’s a challenge because it’s a very patient-specific decision. Patient has to want to have surgery. They have to have an appropriate physiology to tolerate a surgical intervention. And in many regards, that hasn’t changed in the last 20 years. We need to know that they have adequate lung function, that they have an absence of comorbidities that might preclude a general anesthetic and the stress of surgery...
It’s a challenge because it’s a very patient-specific decision. Patient has to want to have surgery. They have to have an appropriate physiology to tolerate a surgical intervention. And in many regards, that hasn’t changed in the last 20 years. We need to know that they have adequate lung function, that they have an absence of comorbidities that might preclude a general anesthetic and the stress of surgery. But on an anatomic level, if the disease is resectable and the risk is acceptable within that patient’s physiology, a lot of disease is resectable. I think because of some of these trials that have been done in the past, a lot of patients were considered unresectable just on the basis of the presence of lymph nodes in the ipsilateral mediastinal compartments.
But you can have positive lymph nodes there that don’t really add any extra morbidity to the resection. Every time we do a lobectomy for stage one lung cancer, we do a complete mediastinal lymph node dissection, and there’s no added morbidity to doing that.
So if they’re positive lymph nodes that are resectable through a usual surgery, it’s not a reason to preclude that patient being offered the neoadjuvant therapy, which seems to bring a lot of benefit from a survival standpoint. And also might make the operation less invasive and less extensive from a parenchymal standpoint. So a lot of it comes with the usual expertise of your thoracic surgeons with whom you work. It’s important to know what your data is, what your outcomes are, so that you can have an informed discussion with a patient about what your center can offer that patient, versus the other competing alternatives, which are often very good as well.
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