Submit to Cancers Review for Cancers Propose a Special Issue

Journal Browser

► Journal Browser

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

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Published Papers

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 27130

Share This Special Issue

Special Issue Editor

Prof. Dr. Francesco Petrella

E-Mail Website
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
Special Issues, Collections and Topics in MDPI journals

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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

Published Papers (11 papers)

Download All Papers

Editorial

Jump to: Research, Review, Other

5 pages, 199 KiB

Open AccessEditorial

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 1100

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.

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

2 pages, 154 KiB

Open AccessEditorial

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 1336

Abstract

[...] Full article

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

Research

Jump to: Editorial, Review, Other

12 pages, 9594 KiB

Open AccessArticle

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 678

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Figure 1

12 pages, 2434 KiB

Open AccessArticle

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 1247

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Graphical abstract

13 pages, 588 KiB

Open AccessArticle

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 - 08 Jan 2023

Cited by 3 | Viewed by 1665

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Figure 1

10 pages, 2281 KiB

Open AccessArticle

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 - 04 Jul 2022

Cited by 3 | Viewed by 1795

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Figure 1

12 pages, 578 KiB

Open AccessArticle

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 9 | Viewed by 2545

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Graphical abstract

12 pages, 487 KiB

Open AccessArticle

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 - 08 Dec 2020

Cited by 6 | Viewed by 1918

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

15 pages, 314 KiB

Open AccessReview

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 23 | Viewed by 3197

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

24 pages, 4146 KiB

Open AccessReview

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 28 | Viewed by 8514

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Graphical abstract

Other

Jump to: Editorial, Research, Review

9 pages, 1515 KiB

Open AccessCommentary

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 1566

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 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

(This article belongs to the Special Issue The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives)

► Show Figures

Figure 1

Journal Menu

Journal Browser

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

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (11 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI