The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 29204

Special Issue Editor


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Guest Editor
1. Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
2. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
Interests: lung cancer surgery; thoracic oncology; early-stage lung cancer; locally advanced lung cancer
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Special Issue Information

Dear Colleagues,

Lung cancer is the second most common cancer and the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths. Although it mainly occurs in older people, aged 70 or more, it may be diagnosed in younger patients, often with very aggressive features.

Historically, early-stage lung cancers have been approached by surgical resection in fit patients and by radiotherapy in fragile or high-risk patients not amenable to aggressive treatments; locally advanced lung cancer usually benefit from multimodal approaches, combining induction treatments, surgical resection and post-operative radiotherapy (until stage IIIA).

Stage IIIB patients are not treated by surgery, and only chemo-radiotherapy or other non-surgical treatments are taken into consideration. Stage IV patients (metastatic disease) do not benefit from surgery and are treated using chemotherapy, biological treatments, immunotherapy and radiotherapy when needed; moreover, thoracic surgeons may still play a role in controlling symptoms and treating or preventing life-threatening conditions (e.g., tracheal obstruction, cardiac tamponade from pericardial effusion, recurrent pleural effusion).

In this Special Issue, we would like to focus on the role of surgical treatment of lung cancer, ranging from radical approaches to early-stage lung cancer to combined approached to locally advanced tumors as well as palliative approaches for metastatic diseases.

It is our pleasure to lead such a comprehensive issue, and we look forward to receiving your valuable contribution.

Prof. Dr. Francesco Petrella
Guest Editor

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Keywords

  • lung cancer surgery
  • thoracic oncology
  • early-stage lung cancer
  • locally advanced lung cancer

Published Papers (11 papers)

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Editorial

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5 pages, 199 KiB  
Editorial
Is It Time to Cross the Pillars of Evidence in Favor of Segmentectomies in Early-Stage Non-Small Cell Lung Cancer?
by Luca Bertolaccini and Lorenzo Spaggiari
Cancers 2023, 15(7), 1993; https://doi.org/10.3390/cancers15071993 - 27 Mar 2023
Cited by 6 | Viewed by 1182
Abstract
In the debate on lobectomy versus segmentectomy for the treatment of early-stage non-small cell lung cancer (NSCLC), currently, we have reached two pillars of knowledge, like Jachim and Boaz, which have encompassed the actual boundary of the literature published up until now [...] [...] Read more.
In the debate on lobectomy versus segmentectomy for the treatment of early-stage non-small cell lung cancer (NSCLC), currently, we have reached two pillars of knowledge, like Jachim and Boaz, which have encompassed the actual boundary of the literature published up until now [...] Full article
2 pages, 154 KiB  
Editorial
The Role of Surgery in Lung Cancer Treatment
by Francesco Petrella
Cancers 2020, 12(10), 2777; https://doi.org/10.3390/cancers12102777 - 28 Sep 2020
Cited by 2 | Viewed by 1442

Research

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12 pages, 9594 KiB  
Article
Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study
by Alain Bernard, Jonathan Cottenet, Pierre-Benoit Pages and Catherine Quantin
Cancers 2023, 15(13), 3283; https://doi.org/10.3390/cancers15133283 - 22 Jun 2023
Cited by 1 | Viewed by 791
Abstract
Background. The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). Methods. All patients who underwent limited [...] Read more.
Background. The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). Methods. All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013–2020). We described between-hospital differences in the MIA rate over four periods (2013–2014, 2015–2016, 2017–2018, and 2019–2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. Results. From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019–2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. Conclusions. We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions. Full article
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12 pages, 2434 KiB  
Article
CT-Derived Sarcopenia and Outcomes after Thoracoscopic Pulmonary Resection for Non-Small Cell Lung Cancer
by Arpad Hasenauer, Céline Forster, Johan Hungerbühler, Jean Yannis Perentes, Etienne Abdelnour-Berchtold, Joachim Koerfer, Thorsten Krueger, Fabio Becce and Michel Gonzalez
Cancers 2023, 15(3), 790; https://doi.org/10.3390/cancers15030790 - 27 Jan 2023
Cited by 3 | Viewed by 1392
Abstract
We aimed to evaluate whether computed tomography (CT)-derived preoperative sarcopenia measures were associated with postoperative outcomes and survival after video-assisted thoracoscopic (VATS) anatomical pulmonary resection in patients with early-stage non-small cell lung cancer (NSCLC). We retrospectively reviewed all consecutive patients that underwent VATS [...] Read more.
We aimed to evaluate whether computed tomography (CT)-derived preoperative sarcopenia measures were associated with postoperative outcomes and survival after video-assisted thoracoscopic (VATS) anatomical pulmonary resection in patients with early-stage non-small cell lung cancer (NSCLC). We retrospectively reviewed all consecutive patients that underwent VATS anatomical pulmonary resection for NSCLC between 2012 and 2019. Skeletal muscle mass was measured at L3 vertebral level on preoperative CT or PET/CT scans to identify sarcopenic patients according to established threshold values. We compared postoperative outcomes and survival of sarcopenic vs. non-sarcopenic patients. A total of 401 patients underwent VATS anatomical pulmonary resection for NSCLC. Sarcopenia was identified in 92 patients (23%). Sarcopenic patients were predominantly males (75% vs. 25%; p < 0.001) and had a lower BMI (21.4 vs. 26.5 kg/m2; p < 0.001). The overall postoperative complication rate was significantly higher (53.2% vs. 39.2%; p = 0.017) in sarcopenic patients and the length of hospital stay was prolonged (8 vs. 6 days; p = 0.032). Two factors were associated with postoperative morbidity in multivariate analysis: BMI and American Society of Anesthesiologists score >2. Median overall survival was comparable between groups (41 vs. 46 months; p = 0.240). CT-derived sarcopenia appeared to have a small impact on early postoperative clinical outcomes, but no effect on overall survival after VATS anatomical lung resection for NSCLC. Full article
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13 pages, 588 KiB  
Article
The Impact of Surgical Experience in VATS Lobectomy on Conversion and Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database
by Luca Bertolaccini, Giulia Fornaro, Oriana Ciani, Elena Prisciandaro, Roberto Crisci, Rosanna Tarricone and Lorenzo Spaggiari
Cancers 2023, 15(2), 410; https://doi.org/10.3390/cancers15020410 - 8 Jan 2023
Cited by 4 | Viewed by 1830
Abstract
Objectives: Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii) to assess the impact [...] Read more.
Objectives: Although unexpected conversion during Video-Assisted Thoracic Surgery (VATS) lobectomy is up to 23%, the effects on postoperative outcomes remain debatable. This retrospective study aimed: (i) to identify potential preoperative risk factors of VATS conversion to standard thoracotomy; (ii) to assess the impact of surgical experience in VATS lobectomy on conversion rate and patient health-related quality of life. Methods: We extracted detailed information on VATS lobectomy procedures performed consecutively (2014–2019). Predictors of conversion were assessed with univariable and multivariable logistic regressions. To assess the impact of VATS lobectomy experience, observations were divided according to surgeons’ experiences with VATS lobectomy. The impact of VATS lobectomy experience on conversion and occurrence of postoperative complications was evaluated using logistic regressions. The impact of VATS lobectomy experience on EuroQoL-5D (EQ-5D) scores at discharge was assessed using Tobit regressions. Results: A total of 11,772 patients underwent planned VATS for non-small-cell lung cancer (NSCLC), with 1074 (9.1%) requiring conversion to thoracotomy. The independent predictors at multivariable analysis were: FEV1% (OR = 0.99; 95% CI: 0.98–0.99, p = 0.007), clinical nodal involvement (OR = 1.43; 95% CI: 1.08–1.90, p = 0.014). Experienced surgeons performed 4079 (34.7%) interventions. Experience in VATS lobectomy did not show a relevant impact on the risk of open surgery conversion (p = 0.13) and postoperative complications (p = 0.10), whereas it showed a significant positive impact (p = 0.012) on EQ-5D scores at discharge. Conclusions: Clinical nodal involvement was confirmed as the most critical predictor of conversion. Greater experience in VATS lobectomy did not decrease conversion rate and postoperative complications but was positively associated with postoperative patient quality of life. Full article
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10 pages, 2281 KiB  
Article
Lobe-Specific Analysis of Sublobar Lung Resection for NSCLC Patients with Tumors ≤ 2 cm
by Xi Lei, Ning Zhou, Hao Zhang, Tong Li, Fan Ren, Bo Zhang, Xiongfei Li, Lingling Zu, Zuoqing Song and Song Xu
Cancers 2022, 14(13), 3265; https://doi.org/10.3390/cancers14133265 - 4 Jul 2022
Cited by 4 | Viewed by 1942
Abstract
(1) Background: Sublobar resection can be used as an alternative surgical strategy for early-stage non-small-cell lung cancer (NSCLC) patients. However, the choice between wedge resection and segmentectomy remains contentious. In this study, we investigated the optimal surgical procedure for sublobar resection in patients [...] Read more.
(1) Background: Sublobar resection can be used as an alternative surgical strategy for early-stage non-small-cell lung cancer (NSCLC) patients. However, the choice between wedge resection and segmentectomy remains contentious. In this study, we investigated the optimal surgical procedure for sublobar resection in patients with NSCLC ≤ 2 cm with a lobe-specific analysis; (2) Methods: Data for patients with T1N0M0 with a diameter of ≤2 cm who had undergone sublobar resection were retrieved. Propensity score matching (PSM) was used to reduce the inherent bias, and the Kaplan–Meier method and log-rank tests were used to assess the differences in survival; (3) Results: A total of 1882 patients were identified after the PSM. Patients with NSCLC ≤ 2 cm who had undergone segmentectomy showed better survival than those who had undergone wedge resection. However, when NSCLC was ≤1 cm, there was no significant difference in OS between the two groups. This demonstrated an OS advantage of segmentectomy over wedge resection for patients with NSCLC tumors of 1–2 cm (p = 0.024). Further analysis indicated that this survival benefit was only observed in patients with right upper NSCLC of 1–2 cm, but not with NSCLC in the other four lobes; (4) Conclusions: Segmentectomy showed a greater survival benefit than wedge resection only in patients with NSCLC of 1–2 cm, particularly those with primary tumors in the right upper lobe. Therefore, we propose a lobe-specific sublobar resection strategy for early-stage NSCLC patients (tumors of 1–2 cm) who cannot tolerate lobectomy. Full article
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12 pages, 578 KiB  
Article
The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience
by Francesco Petrella, Davide Radice, Juliana Guarize, Gaia Piperno, Cristiano Rampinelli, Filippo de Marinis and Lorenzo Spaggiari
Cancers 2021, 13(2), 228; https://doi.org/10.3390/cancers13020228 - 10 Jan 2021
Cited by 10 | Viewed by 2675
Abstract
Background: the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation. Methods: the impact of MDT was classified as follows: confirmation: same [...] Read more.
Background: the aim of this paper is to quantify multidisciplinary team meeting (MDT) impact on the decisional clinical pathway of thoracic cancer patients, assessing the modification rate of the initial out-patient evaluation. Methods: the impact of MDT was classified as follows: confirmation: same conclusions as out-patient hypothesis; modification: change of out-patient hypothesis; implementation: definition of a clear clinical track/conclusion for patients that did not receive any clinical hypothesis; further exams required: the findings that emerged in the MDT meeting require further exams. Results: one thousand consecutive patients evaluated at MDT meetings were enrolled. Clinical settings of patients were: early stage lung cancer (17.4%); locally advanced lung cancer (27.4%); stage IV lung cancer (9.8%); mesothelioma (1%); metastases to the lung from other primary tumors (4%); histologically proven or suspected recurrence from previous lung cancer (15%); solitary pulmonary nodule (19.2%); mediastinal tumors (3.4%); other settings (2.8%). Conclusions: MDT meetings impact patient management in oncologic thoracic surgery by modifying the out-patient clinical hypothesis in 10.6% of cases; the clinical settings with the highest decisional modification rates are “solitary pulmonary nodule” and “proven or suspected recurrence” with modification rates of 14.6% and 13.3%, respectively. Full article
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12 pages, 487 KiB  
Article
Prognostic Value of Red Blood Cell Distribution Width in Resected pN1 Lung Adenocarcinoma
by Francesco Petrella, Monica Casiraghi, Davide Radice, Elena Prisciandaro, Stefania Rizzo and Lorenzo Spaggiari
Cancers 2020, 12(12), 3677; https://doi.org/10.3390/cancers12123677 - 8 Dec 2020
Cited by 6 | Viewed by 2066
Abstract
Background: Red blood cell distribution width is a measure of the variation of erythrocyte volume and has recently been advocated as a prognostic tool in neoplastic and non-neoplastic diseases. We studied the prognostic role of preoperative red blood cell distribution width (RDW) in [...] Read more.
Background: Red blood cell distribution width is a measure of the variation of erythrocyte volume and has recently been advocated as a prognostic tool in neoplastic and non-neoplastic diseases. We studied the prognostic role of preoperative red blood cell distribution width (RDW) in resected pN1 lung adenocarcinoma patients. Methods: Sixty-seven consecutive pN1 lung adenocarcinoma patients operated in the last two years were retrospectively evaluated in the present study. Age, sex, smoking status, type of surgical resection, neoadjuvant and adjuvant treatments, pathological stage, T and N status, tumor size, preoperative hemoglobin (Hb) and RDW, preoperative neutrophils, lymphocytes, and their ratio were collected for each patient. Outpatient follow-up was performed and date of relapse was recorded. Results: There were 24 females (35.8%). Twenty-eight patients (41.8%) belonged to stage 3A and thirty-nine patients (58.2%) to stage 2B. Mean preoperative RDW % was 14.1 (IQR: 12.9–14.8). Univariate analysis disclosed preoperative RDW as strictly related to disease-free survival (p = 0.02), which was confirmed in the exploratory multivariable analysis (p = 0.003). Conclusions: Pre-operative RDW is an effective prognostic factor of disease-free survival in resected pN1 lung adenocarcinoma; it could therefore be considered as a further tool for planning postoperative adjuvant treatments and setting up an adequate follow-up program. Full article
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Review

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15 pages, 314 KiB  
Review
Current Surgical Indications for Non-Small-Cell Lung Cancer
by Nathaniel Deboever, Kyle G. Mitchell, Hope A. Feldman, Tina Cascone and Boris Sepesi
Cancers 2022, 14(5), 1263; https://doi.org/10.3390/cancers14051263 - 28 Feb 2022
Cited by 25 | Viewed by 3520
Abstract
With recent strides made within the field of thoracic oncology, the management of NSCLC is evolving rapidly. Careful patient selection and timing of multi-modality therapy to permit the optimization of therapeutic benefit must be pursued. While chemotherapy and radiotherapy continue to have a [...] Read more.
With recent strides made within the field of thoracic oncology, the management of NSCLC is evolving rapidly. Careful patient selection and timing of multi-modality therapy to permit the optimization of therapeutic benefit must be pursued. While chemotherapy and radiotherapy continue to have a role in the management of lung cancer, surgical therapy remains an essential component of lung cancer treatment in early, locally and regionally advanced, as well as in selected, cases of metastatic disease. Recent and most impactful advances in the treatment of lung cancer relate to the advent of immunotherapy and targeted therapy, molecular profiling, and predictive biomarker discovery. Many of these systemic therapies are a part of the standard of care in metastatic NSCLC, and their indications are expanding towards surgically operable lung cancer to improve survival outcomes. Numerous completed and ongoing clinical trials in the surgically operable NSCLC speak to the interest and importance of the multi-modality therapy even in earlier stages of NSCLC. In this review, we focus on the current standard of care indications for surgical therapy in stage I-IV NSCLC as well as on the anticipated future direction of multi-disciplinary lung cancer therapy. Full article
24 pages, 4146 KiB  
Review
The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art
by François Montagne, Florian Guisier, Nicolas Venissac and Jean-Marc Baste
Cancers 2021, 13(15), 3711; https://doi.org/10.3390/cancers13153711 - 23 Jul 2021
Cited by 33 | Viewed by 9035
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the [...] Read more.
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients’ characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients’ comfort. Full article
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Other

9 pages, 1515 KiB  
Commentary
The “Balloon-Like” Sign: Differential Diagnosis between Postoperative Air Leak and Residual Pleural Space: Radiological Findings and Clinical Implications of the Young–Laplace Equation
by Francesco Petrella, Stefania Rizzo, Luca Bertolaccini, Monica Casiraghi, Lara Girelli, Giorgio Lo Iacono, Antonio Mazzella and Lorenzo Spaggiari
Cancers 2022, 14(14), 3533; https://doi.org/10.3390/cancers14143533 - 20 Jul 2022
Viewed by 1723
Abstract
In this paper, we propose a radiological sign for an appropriate differential diagnosis between postoperative pleural space and active air leak after lung resection. In the case of residual pleural space without any active air leak, the lung takes the form of a [...] Read more.
In this paper, we propose a radiological sign for an appropriate differential diagnosis between postoperative pleural space and active air leak after lung resection. In the case of residual pleural space without any active air leak, the lung takes the form of a round balloon due to the hyperinflation condition, which is governed by the Young–Laplace equation describing the capillary pressure difference sustained across the interface between two static fluids, such as water and air, due to the phenomenon of wall tension. The two principal mechanisms by which a lung forms a spherical image are shear-controlled detachment induced by shear stress on the membrane surface, and spontaneous detachment induced by a gradient in Young–Laplace pressure. On the contrary, the lung maintains its tapered shape in the case of an active air leak because the continuous air refill does not allow a complete parenchyma re-expansion. Full article
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