Nabil P. Rizk, MD, MS, MPH, chief, Division of Thoracic Surgery, Hackensack University Medical Center, co-director, Thoracic Oncology, John Theurer Cancer Center, discusses the evolving role of surgery in lung cancer.

Historically, surgery and adjuvant chemotherapy were associated with significant morbidity in lung cancer, explains Rizk. ​Notably, only 50% of patients were able to tolerate adjuvant chemotherapy.

However, recovery for surgery has become much easier with the advent of minimally invasive and robotic approaches, Rizk adds. Now, patients can be released from the hospital within 1 ​to 3 days ​of undergoing a lobectomy, says Rizk. Then, patients are often eligible to start chemotherapy within 2 to 3 weeks.

As such, the argument that chemotherapy cannot be reliably administered in the adjuvant setting is no longer applicable with regard to minimally invasive surgery, Rizk concludes.

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Nabil P. Rizk, MD, MS, MPH, discusses the evolving role of surgery in lung cancer.

Dr. Rizk on the Evolution of Surgery in Lung Cancer 

Nabil P. Rizk, MD, MS, MPH, chief, Division of Thoracic Surgery, Hackensack University Medical Center, co-director, Thoracic Oncology, John Theurer Cancer Center, discusses the role of anatomic surgical resection in nonmetastatic lung cancer.

According to Rizk, surgery plays a vital, and potentially growing role in this space. Anatomic lung resection appears to be the optimal treatment for patients with early-stage disease who can undergo surgery.

For patients with limited physiologic capacity, stereotactic body radiation therapy (SBRT) or anatomic lung resection may be considered. 

Rizk highlights that for patients with aggressive subtypes of lung cancer like micropapillary lung adenocarcinoma or solid tumor type, surgery may not yield more benefit than SBRT, and a radiation oncologist will often be consulted to determine the best treatment.

Nabil P. Rizk, MD, MS, MPH, discusses the role of anatomic surgical resection in nonmetastatic lung cancer.

Dr. Rizk on the Role of Surgery in Nonmetastatic Lung Cancer

Nabil P. Rizk, MD, MS, MPH, chief, Division of Thoracic Surgery, Hackensack University Medical Center, co-director, Thoracic Oncology, John Theurer Cancer Center, discusses criteria for surgical resection in lung cancer. 

Physiological issues are the first thing to look out for in patients with lung cancer, says Rizk. While older age is not a reason to not operate on a patient, poor lung capacity is, he adds. As most patients with lung cancer have some degree of emphysema, it is important to test up front to determine if surgery is possible and to ensure that quality of life is maintained. 

With regard to technical issues, Rizk says that many structures in the chest can be invaded by cancer, so the question then becomes, "which are resectable?" Another challenge is deciding whether to operate first prior to administering chemotherapy. The question of whether chemotherapy will make a patient more resectable or not remains an area of controversy, says Rizk. Some believe that chemotherapy may somewhat shrink a large tumor, thus allowing for a smaller operation; however, most data do not support that notion, he adds.

As such, surgeons are tasked with deciding up front whether a patient will be able to tolerate a larger operation or not. If they are able to tolerate a large operation prior to chemotherapy initiation, then they should be able to tolerate it afterward, concludes Rizk. 

Nabil P. Rizk, MD, MS, MPH, discusses criteria for surgical resection in lung cancer. 
 

Nabil P. Rizk, MD, MS, MPH

Articles

Dr. Rizk on the Evolution of Surgery in Lung Cancer

Dr. Rizk on the Role of Surgery in Nonmetastatic Lung Cancer

Dr. Rizk on Eligibility Criteria for Surgical Resection in Lung Cancer