MDT lung cancer care: Input from the Surgical Oncologist

Abstract

Although there have been many advancements in the multidisciplinary management of non-small cell lung cancer (NSCLC), surgery remains the primary modality of choice for resectable lung cancer when the patient is able to tolerate lung resection physiologically. There have been recent advances in surgical diagnosis and treatment of lung cancer. Increasing use of low-dose computed tomography (CT) screening for lung cancer has resulted in increased detection of small peripheral nodules or semi-solid ground glass opacities. Here, we review different modalities of localization techniques that have been used to aid surgical excisional biopsy when needle biopsy has failed to provide tissue diagnosis. We also report on the current debates regarding the use of sublobar resections for Stage I NSCLC as well as the surgical management of locally advanced NSCLC. Finally, we discuss the complex surgical management of T4 NSCLC lung cancers.

CT‐guided percutaneous hookwire localization increases the efficacy and safety of VATS for pulmonary nodules

“…In theory, the combination of a localization technique and VATS makes the procedure more efficient by means of radical resection, diagnostic accuracy, reduction of procedure time, and a lower conversion rate to (mini‐)thoracotomy . The highest level of evidence for efficacy and safety currently appears to support microcoils, radiolabeling, and hookwire localization techniques .…”

“…29,30 In theory, the combination of a localization technique and VATS makes the procedure more efficient by means of radical resection, diagnostic accuracy, reduction of procedure time, and a lower conversion rate to (mini-)thoracotomy. 19 The highest level of evidence for efficacy and safety currently appears to support microcoils, radiolabeling, and hookwire localization techniques. [19][20][21][22][23][24] A randomized controlled trial comparing CT-PHL to 99n Technetium labeled albumin localization in small nodules did not show significant difference between both techniques.…”

“…19 The highest level of evidence for efficacy and safety currently appears to support microcoils, radiolabeling, and hookwire localization techniques. [19][20][21][22][23][24] A randomized controlled trial comparing CT-PHL to 99n Technetium labeled albumin localization in small nodules did not show significant difference between both techniques. However, both techniques were significantly better at localizing nodules than finger palpation during VATS.…”

“…The third group consists of techniques wherein localizers are inserted transbronchially in which specialized localization equipment and imaging techniques such as CT‐fluoroscopy are required . Microcoils, radiolabeling, and hookwire localization techniques have currently the highest level of evidence for efficacy and safety . The aim of this study was to evaluate the efficacy and safety of CT‐PHL prior to VATS in terms of complete resection, histological diagnosis, complications, conversion rate to thoracotomy, and duration of procedures.…”

“…18 Microcoils, radiolabeling, and hookwire localization techniques have currently the highest level of evidence for efficacy and safety. [19][20][21][22][23][24] The aim of this study was to evaluate the efficacy and safety of CT-PHL prior to VATS in terms of complete resection, histological diagnosis, complications, conversion rate to thoracotomy, and duration of procedures.…”