Surgery for early lung cancer

The majority of my work is with patients who have early lung cancer. In the earliest stages (less than 4cm, and no lymph nodes are involved, no disease outside the chest) there are many treatment options available including upfront surgery, radiotherapy or ablation.

Regarding radiotherapy as an option, two trials suggested survival with radiotherapy is better in early stage lung cancer, however the studies were small and closed prematurely as they could not recruit enough patients to complete.[1] There are no results to confirm the medium to long term findings, highlighting the difficulties in the interpretation of incomplete clinical trials.[2]

If you decide to have surgery for early stage lung cancer, I conducted VIOLET, a large clinical trial of over 500 participants that revealed less pain, shorter hospital stay, and less complications when the operation was performed using keyhole surgery.[3] The evidence shaped my current approach using one keyhole to perform the entire operation. Moreover, my further studies also show less pain and better mobility in the first year after surgery compared to operations where more than one keyhole was used.[4]

Whilst single incision keyhole surgery is my standard approach, some patients may not be suitable (if there is a safety concern or to ensure complete cancer clearance), in which case I will either add more keyholes or change to an open incision to complete the procedure.

Most patients will be suitable for day case surgery and allowed home (with or without a drain) as long as your pain is controlled and you feel well and confident.

At any stage, please feel free to contact me to discuss your options.

References

1. Chang JY et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. The Lancet Oncology. 2015;16:630-637.

2. Treasure T et al. SABR in early operable lung cancer: time for evidence. The Lancet Oncology. 2015;16:597-598.

3. Lim E, et al. Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer. NEJM Evid 2022;1(3). DOI: 10.1056/EVIDoa2100016

4. Lim E, et al. Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer. JTCVS Open, Volume 19, 296 - 308