Dr Backhus on Defining Borderline-Resectable Lung Cancer

Leah Backhus, MD, MPH, FACS, professor, University Medical Line, Cardiothoracic Surgery; co-director, Thoracic Surgery Clinical Research Program; associate program director, Thoracic Track, CT Surgery Residency Training Program; Thelma and Henry Doelger Professor of Cardiovascular Surgery, Stanford Medicine; chief, Thoracic Surgery, VA Palo Alto, discusses the evolving definition of borderline resectable lung cancer, as well as the crucial role of surgeons in the treatment of patients with this disease.

The treatment of patients with borderline resectable lung cancer hinges on precise definitions and assessments of resectability, encompassing both medical and technical operability, Backhus begins. The term “borderline resectable” is sometimes used interchangeably with “unresectable” to refer to both technically and medically inoperable disease, although it is important to distinguish between different types of lung cancer cases, Backhus emphasizes. Recent advancements in surgical techniques, including sublobar resections, have expanded the pool of patients with lung cancer who are candidates for surgery, allowing more patients with early-stage disease to safely undergo minimally invasive procedures, Backhus says. These developments are supported by data from 2 randomized, prospective clinical trials that demonstrated the safety and efficacy of sublobar resections in patients with lung cancer, Backhus describes.

A multidisciplinary approach involving medical oncologists, thoracic surgeons, interventional pulmonologists, radiation oncologists, and other specialists, is essential for the treatment of patients with lung cancer, according to Backhus. A key aspect of multidisciplinary care is ensuring that surgeons are involved in the treatment decision-making process from the outset. Their expertise is vital for assessing the feasibility of achieving an R0 resection in each patient and balancing the surgery’s technical requirements against the patients’ physiological and perioperative risks, Backhus notes. Many lung cancer cases are deemed unresectable without a thorough surgical evaluation, underscoring the importance of consulting a surgeon to provide a comprehensive surgical assessment before determining the most appropriate treatment strategy for each patient, Backhus concludes.