Management of Patients With Stage I Lung Cancer

Abstract

The treatment of stage I non-small-cell lung cancer has advanced markedly over the past century. The transition from therapeutic nihilism with ensured mortality to radical surgery with pneumonectomy to rational oncologic-based resection has resulted in dramatically improved outcomes and reduced morbidity. The superiority of anatomic resection with lobectomy over sublobar resection for fit patients with stage I disease, where more than one half of all patients should expect to be cured, is backed by level 1 evidence. Minimally invasive approaches have further decreased morbidity and mortality, and prospective trials continue to assess whether sublobar resection is appropriate in more select circumstances for tumors < 2 cm. Interest in studying the patient at high risk for complications after lobectomy has been spurred by recent advances in surgical, radiotherapy, and ablative treatment options. In particular, provocative results with stereotactic body radiotherapy have led to rapid adoption in clinical practice with a resultant decrease in the number of untreated patients. A comparison of outcomes across studies of competing modalities remains challenging given the potential impact of selection bias in single-arm trials, and attempts to conduct randomized studies have been largely unsuccessful. Given the uncertainty in defining optimal therapy, patients are best served by a multidisciplinary team of thoracic surgeons, radiation oncologists, pulmonologists, and chest and interventional radiologists to ensure that they receive the evaluation and treatment best suited not only to their tumor and medical challenges but also to their concerns, fears, and values.

Young at Heart: Is That Good Enough for Computed Tomography Screening?

“…Other available data are limited by selection bias with fitter patients being allocated surgery, and also the lack of histology in some patients who undergo SABR. (9). Nevertheless (even if surgery were to remain the superior treatment), more widespread availability of SABR would improve survival rates in the non-surgical group, thereby diminishing the differences in survival and potentially making screening patients who may not be surgical candidates, more worthwhile than suggested in the present study.…”

Summary of best evidence for enhanced recovery after surgery for patients undergoing lung cancer operations

“…Lobectomy is the treatment of choice in the early stage (stage I or II) of lung cancer, but even with minimally invasive surgery, 1 , 2 the resulting surgical incision is still one of the most painful, 3 and there is a significant risk of perioperative complications. 4 Complications not only reduce patient satisfaction, but also may impact patients with a huge associated socioeconomic impact in terms of quality of life, functional recovery, and health-related quality of life.…”

Impact of Sarcopenia on Early Postoperative Complications in Early-Stage Non–Small-Cell Lung Cancer

“…The overall 5-year relative survival rate of lung cancer has improved from 11.2% for men and 14.7% for women among patients diagnosed between 1993 and 1997 to 19.3% for men and 28.2% for women among patients diagnosed between 2008 and 2012 [2,3]. The standard treatment for patients with stage I nonsmall-cell lung cancer (NSCLC) is anatomical surgical resection and appropriate mediastinal lymph node dissection; this treatment renders a chance of cure, with overall documented 5-year survival of up to 75% after surgery [4,5]. Perioperative management has improved over the past decades, but postoperative morbidity still occurs as the patient population ages and the complexity of the procedure increases alongside the more prevalent use of neo-https://doi.org/10.5090/kjtcs.2020.53.…”