Daniela Molena, MD, director, Esophageal Surgery Program, Memorial Sloan Kettering Cancer Center, discusses the use of lung-sparing surgery in early-stage lung cancer.

The future of surgery will move toward less morbid and more lung-sparing approaches, says Molena. As in breast cancer, expansive surgeries and resections were done until data demonstrated that a smaller resection could result in equivalent survival outcomes, explains Molena.

With smaller surgeries, quality of life has improved dramatically, says Molena. Minimally invasive approaches are important because only so much lung can be resected before it starts to adversely affect the patient’s functionality. As such, the field is going to see more sublobar resections or white-light resections, when appropriate.

As the field moves in that direction, surgeons are going to become more reliant on technology to identify which patients are candidates for these approaches versus lobectomy. Such technology will also enable better assessments of the lymphatic drainage, the lymph node, and the original disease in patients, concludes Molena.

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Dr. Molena on Lung-Sparing Surgery in Early-Stage Lung Cancer

Daniela Molena, MD, director, Esophageal Surgery Program, Memorial Sloan Kettering Cancer Center, discusses factors that determine if a patient with non—small cell lung cancer (NSCLC) is eligible for surgical resection.  

Early-stage lung cancer is curable with surgery, explains Molena. If a high-risk patient presents with a nodule on their CT scan, it should not be ignored because it could progress into later-stage disease and render the patient ineligible for surgical resection. 

Other factors such as the patient’s functional status and ability to tolerate anesthesia also determine if surgery is an option, says Molena. 

The majority of patients with NSCLC have some degree of lung damage caused by smoking, explains Molena. As such, determining how much of the lung can be resected is another important consideration. In some cases, compromise must be made to ensure that enough lung can be removed without jeopardizing the patient’s postoperative function, says Molena.  

For example, lobectomy remains the standard surgery for this patient population, says Molena. However, if a patient has low borderline pulmonary function and small cancer, less of the lung may be taken. 

Daniela Molena, MD, discusses factors that determine if a patient with non–small cell lung cancer is eligible for surgical resection.  
 

Dr. Molena on Determining Surgical Resection Eligibility in NSCLC

Daniela Molena, MD, director, Esophageal Surgery Program, Memorial Sloan Kettering Cancer Center, discusses what she believes is the Achilles heel of endoscopic resection in patients with esophageal cancer.

According to Molena, the challenge today is the inability to predict nodal disease. It’s unknown whether a patient has nodal disease or not, but tumor characteristics can be used to estimate the risk of nodal disease.

If a patient is at high risk of nodal disease, then it is determined that endoscopic resection is not a good option; instead, they should have a more aggressive approach, such as a pharyngectomy. For those who are considered low risk of nodel disease, endoscopic resection is a safe option, Molena explains. For the future, she says it is necessary to find ways to identify nodal disease in patients without having to predict the risk.

View more from the 2019 Gastrointestinal Cancers Symposium 

Daniela Molena, MD, discusses what she believes is the Achilles heel of endoscopic resection in patients with esophageal cancer.

Daniela Molena, MD

Articles

Dr. Molena on Lung-Sparing Surgery in Early-Stage Lung Cancer

Dr. Molena on Determining Surgical Resection Eligibility in NSCLC

Dr. Molena on Challenges With Endoscopic Resection in Esophageal Cancers