Surgical Intervention
Surgery for Non-Small Cell Lung Cancer (NSCLC)
Surgery for Small Cell Lung Cancer (SCLC)
- Resectability of tumor should be fully assessed
- May offer the best chance of survival & possible cure in non-small cell lung cancer (NSCLC) patients with Stage I-II disease
- May be considered in patients with N2 disease responsive to induction chemotherapy
- Surgery is recommended for patients with the following:
- ≥8 mm solid nodule on LDCT screening that has high probability of cancer as shown on PET/CT scan
- ≥8 mm solid nodule that increased in size in chest CT &/or PET/CT scan with high probability for cancer
- ≥15 mm solid nodule with the same measurements in LDCT after 6 months or in PET/CT scan with high probability for cancer
- ≥6 mm part solid nodule with ≥8 mm solid component in follow-up LDCT with high probability for cancer in PET/CT scan
- New or growing part solid nodule with ≥4 mm solid component in LDCT with high probability for cancer in chest CT scan with or without contrast &/or PET/CT scan
- New or growing NS nodule ≥20 mm in size during follow-up or annual LDCT
- Treatment of choice for stage I & II non-small cell lung cancer (NSCLC)
- In the absence of medical contraindications to surgery, complete resection (ie lobectomy) with clear surgical margins should be achieved as much as possible
- In patients with comorbidities who are not able to tolerate lobectomy (eg patients with impaired pulmonary function), sublobar resection (segmentectomy or wedge resection) is recommended
- Nodal dissection is preferred over simple intraoperative sampling for mediastinal lymph node
- Sleeve lobectomy is recommended for total resection of centrally or locally advanced non-small cell lung cancer (NSCLC)
- Segmental or wedge resection is recommended for patients with impaired pulmonary function
- Surgery in stage IIIA N2 lung cancer is controversial
- Surgery is considered in resectable stage IIIA N0-1 tumors, followed by adjuvant chemotherapy
- Usually not recommended if with involvement of N2; patient may undergo chemotherapy prior to surgery to decrease the tumor size, eliminate micrometastases & to improve patient’s tolerance to procedure
- Video-assisted thoracic surgery (VATS) is a less invasive & reasonable approach for patients with no anatomic or surgical contraindication
- For highly selected patients with recurrent NSCLC, stereotactic radiation surgery & surgical resection of isolated cerebral metastasis are recommended
Surgery for Small Cell Lung Cancer (SCLC)
- Considered only for patients with clinical stage I-IIA & in limited disease (LD) patients with sufficient pulmonary function & no evidence of metastases to mediastinal or supraclavicular lymph nodes
- Patients with clinical stage in excess of T1-2, N0 do not benefit from surgery
- Lobectomy or pneumonectomy should be done followed by detailed dissection of the mediastinal lymph nodes
- Platinum-based adjuvant chemotherapy is recommended after complete resection