67IN - What is the place of less invasive surgery in lung cancer?

Date 29 September 2014
Event ESMO 2014
Session Diagnostic and therapeutic challenges in thoracic malignancies
Topics Non-Small Cell Lung Cancer
Surgical Oncology
Radiation Oncology
Presenter Giulia Veronesi
Citation Annals of Oncology (2014) 25 (suppl_4): iv24-iv25. 10.1093/annonc/mdu305
Authors G. Veronesi
  • Thoracic Surgery, Istituto Europeo di Oncologia, 20141 - Milan/IT




The dissemination of screening programs makes it possible to diagnose more early stage lung cancers than in the past. Screen-detected cancers are generally <15 mm in diameter, and approximately 25% are of low aggressiveness (doubling times > 400 days), some of which may be overdiagnosed. Most stage Ia cancers are not associated with lymph node infiltration, and a recent publication has identified factors predicting lymph node involvement: in the absence of such factors, radical lymphadenectomy may not be necessary, and for screen-detected stage Ia cancers, standard lobectomy plus radical lymphadenectomy may be overtreatment .For such cases it is important to reduce the invasiveness and extent of surgery, and also to explore and validate non-surgical treatments. The traditional open surgical approach (thoracotomy with rib spreading) to lobectomy and segmentectomy is being superseded by minimally invasive video-assisted thoracic surgery (VATS) even in non-academic centres. However, robotic surgery has fewer technical difficulties with shorter surgeon learning time than VATS: the magnified three-dimensional view, greater precision of instrument movements, hand tremor filtration and improved ergonomics overcome the limitations of VATS favouring its use even for more advanced cases. Sublobar resections are considered adequate procedures for patients at high risk of surgical complications (with commodities or age over 75 years), may also be adequate in patients with good performance status and peripheral lung cancer <2 cm. At least three on-going randomized studies with endpoints overall or disease-free survival, are comparing lobar with sublobar resections for stage T1aN0M0 lung cancer, Once the oncological validity of sublobar resection in fit patients is confirmed, future studies will assess stereotactic radiation therapy compared to surgery as a totally non-invasive approach to small cancers; while use of more accurate risk models will allow personalised prevention programs to be followed, in the event of lung cancer diagnosis, by customized and mainly non-invasive local treatments guided by molecular and radiological prognostic factors.


The author has declared no conflicts of interest.