Abstract
Background
Lung resection remains the gold-standard of treatment for non-small cell lung cancer
(NSCLC). British Thoracic Society (BTS) guidelines recommends the pursuit of pre-operative
histological diagnosis and staging where possible. In the absence of pre-operative
histology, surgical treatment can be offered in conjunction with multidisciplinary
team (MDT) and patient consensus. We undertook a single-centre analysis of the accuracy
of the lung cancer MDT in recommending surgical resection for those with suspected
lung malignancy in the absence of pre-operative histological diagnosis over a six-year
period.
Methods
A retrospective review was performed of patients undergoing any pulmonary oncological
resection with therapeutic intent without pre-operative histological diagnosis at
the recommendation of the lung cancer MDT in our unit between May 2016 and July 2022.
Results
270 consecutive patients underwent lung resection for a lung nodule of indeterminate
significance. This accounted for 45% of the oncological resections performed over
this period. The mean age of the cohort was 67.9 years, and 47.4% were male. Overall,
10% of resected specimens (n = 27) were benign on final histopathology. 93% of those
undergoing a lobectomy received a malignant diagnosis. Across the study cohort, surgical
resection was well tolerated with a low complication rate.
Conclusions
Lung cancer resection in the absence of pre-operative histological diagnosis is feasible
in a select patient cohort. This approach requires an experienced multi-disciplinary
team and careful patient counselling. Our study demonstrates this adapted approach
to be a pragmatic solution to the management of indeterminate pulmonary nodules in
centres where biopsy is not routinely available due to existing constraints on the
health system.
Keywords
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Article info
Publication history
Published online: April 15, 2023
Accepted:
April 12,
2023
Received in revised form:
March 30,
2023
Received:
December 10,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
