Approaches to Lung Resection for Early-Stage Cancer

Approaches to lung resection for early stage cancer.

• This survey was posted during November 2006. 
• A total of 41 responses were received; most were from North American surgeons.
• Most surgeons preferred a VATS wedge resection for diagnosis.
• There was a considerable range of approaches for resection, including muscle sparing thoracotomy, muscle dividing thoracotomy, and VATS lobectomy.
• The vast majority of surgeons routinely perform formal lobectomy and mediastinal lymph node dissection for this type of tumor.

Assume for purposes of this survey that the patient in question is a 60 year old man who has a 1.5 cm peripheral RUL lung nodule that is highly suspicious for cancer on CT and PET and is without CT or PET evidence for hilar or mediastinal adenopathy.  No diagnosis has been obtained. The patient is a good surgical risk from a cardiopulmonary standpoint

1. What is your preferred surgical approach for diagnosis in this patient?   Response Percent Response Total     VATS wedge resection 75.6% 31     Open thoracotomy and wedge resection/core needle biopsy 19.5% 8     No diagnosis necessary, proceed with lung resection 4.9% 2 Total Respondents   41 (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) 31.7% 13     Lateral thoracotomy dividing the latissimus dorsi and sparing the serratus 24.4% 10     Posterolateral thoracotomy dividing the latissimus and rhomboids and dividing a rib or performing rib excision 4.9% 2     Video-assisted minimally invasive techniques 39% 16 Total Respondents   41 (skipped this question)   0

3. What is your preferred extent of resection for treating this patient?   Response Percent Response Total     Wedge excision 14.6% 6     Formal segmentectomy 0% 0     Formal lobectomy 85.4% 35 Total Respondents   41 (skipped this question)   0

4. 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 4.9% 2     Routine lymph node sampling 41.5% 17     Routine lymph node dissection 53.7% 22 Total Respondents   41 (skipped this question)   0

5. How many lung resections do you perform annually to treat lung cancer?   Response Percent Response Total 2.4% 1     10-30 19.5% 8     30-50 26.8% 11     50-100 39% 16     > 100 12.2% 5 Total Respondents   41 (skipped this question)   0

6. In what region is your surgical practice based?   Response Percent Response Total     North America 48.8% 20     Europe 34.1% 14     South America 7.3% 3     Asia 9.8% 4     Africa 0% 0 Total Respondents   41 (skipped this question)   0