Approaches to surgical management after induction therapy for resectable lung cancer.

This survey was posted during January and February, 2007.

  • There were a total of 71 survey respondents, most of whom were from North America and Europe.
  • The majority of surgeons perform resection between 2 and 6 weeks after completion of induction therapy.
  • The preferred surgical approach is a muscle sparing thoracotomy or a lateral thoracotomy.
  • The vast majority of surgeons perform routine lymph node dissection or, less commonly, lymph node sampling as part of the operation.
  • Most surgeons staple the bronchus, the majority preferring use of a stapler that does not also cut the tissue.
  • Three fourths of surgeons routinely use a local tissue flap to cover the bronchial stump.

Assume for purposes of this survey that the patient in question is a 60 year old man who has a peripheral T2 RUL lung squamous cell cancer for which chemotherapy (2 cycles, platinum based) and radiation therapy (55 Gy) were administered for biopsy-proven N2 disease.  A substantial clinical response to the treatment has been documented. The patient is a good surgical risk from a cardiopulmonary standpoint.

1. What is your preferred timing for surgery in this patient?
  Response Percent Response Total
    2-4 weeks after completion of therapy
35.2% 25
    4-6 weeks after completion of therapy
59.2% 42
    6-8 weeks after completion of therapy
5.6% 4
Total Respondents   71
(skipped this question)   0
2. What is your preferred approach for surgical therapy in this patient?
  Response Percent Response Total
    Muscle sparing thoracotomy (anterior or lateral)
38% 27
    Lateral thoracotomy dividing the latissimus dorsi and sparing the serratus
50.7% 36
    Posterolateral thoracotomy dividing the latissimus and rhomboids and dividing a rib or performing rib excision
7% 5
    Video-assisted minimally invasive techniques
4.2% 3
Total Respondents   71
(skipped this question)   0
3. What is your standard approach to mediastinal lymph nodes in this patient?
  Response Percent Response Total
    No sampling/dissection necessary if the nodes appear normal
1.4% 1
    Routine lymph node sampling
32.4% 23
    Routine lymph node dissection
66.2% 47
Total Respondents   71
(skipped this question)   0
4. How do you close the bronchial stump in such patients?
  Response Percent Response Total
    Linear cutting stapler
19.7% 14
    Linear stapler, cutting the bronchus distal to the staple line
74.6% 53
    Hand sewn closure
5.6% 4
Total Respondents   71
(skipped this question)   0
5. Do you cover the stump after routine closure in such patients?
  Response Percent Response Total
    No
25.4% 18
    With pericardial fat
19.7% 14
    With adjacent soft tissues
19.7% 14
    With muscle flap
35.2% 25
Total Respondents   71
(skipped this question)   0
6. How many lung resections do you perform annually to treat lung cancer?
  Response Percent Response Total
    <10
2.8% 2
    10 to 30
14.1% 10
    30 to 50
42.3% 30
    50 to 100
26.8% 19
    More than 100
14.1% 10
Total Respondents   71
(skipped this question)   0
7. In what region is your surgical practice based?
  Response Percent Response Total
    North America
63.4% 45
    Europe
25.4% 18
    South America
2.8% 2
    Asia
7% 5
    Africa
1.4% 1
Total Respondents   71
(skipped this question)   0
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