The State of Lung Cancer: A Surgical Perspective

Christopher Wigfield, MD

Christopher Wigfield, MD

By Christopher Wigfield, MD

Despite tremendous advances in cancer care, lung cancer remains one of the deadliest forms of cancer in the world. Lung cancer, including non-small cell lung cancer (NSCLC), is the leading cause of cancer-related death.

In fact, more people die from lung cancer than from colon, breast and prostate cancers combined, according to the American Cancer Society.

In honor of Lung Cancer Awareness Month, Christopher H. Wigfield, MD, thoracic surgeon and assistant professor of surgery, explores the state of lung cancer and the challenges and opportunities that lay ahead of us.

Innovations in Minimally Invasive Surgery

The advent of minimally invasive surgery nearly 20 years ago has revolutionized the surgical care experience. Patients experience less bleeding and pain as well as shorter hospital stays and can return to their lives mere days after such surgeries, a welcome improvement compared to open procedures that require long recovery periods in the hospital.

In surgical lung oncology, surgeons commonly utilize video-assisted thoracic surgery to perform resections, lobectomies or other types of surgeries.

Though growing in popularity, video-assisted thoracic surgery for lung cancer has seen some resistance from thoracic surgeons. Limited visualization of the operative field and hampered maneuverability of the surgical instruments are constraints encountered with standard minimally invasive surgery

The da Vinci robotic-assisted surgery system, however, provides a 3-D view of the patient’s anatomy and ergonomic “wristed” instruments for improved magnification, allowing greater freedom of movement and precision. Although robotic surgery has found widespread utility across many surgical specialties, including urology and gynecology, robot-assisted thoracic surgery is still considered a novel approach.

Consider a study recently published in the Annals of Thoracic Surgery. The first of its kind, researchers compared the outcomes of more than 33,000 lung cancer patients.

As part of their study, the researchers conducted a propensity-matched analysis to compare the outcomes of patients undergoing open, video-assisted or robotic-assisted lobectomy by a high-volume surgeon.

Results showed mortality, hospital length of stay and complications after robotic surgery were far less frequent compared to open lobectomy. What’s more, the researchers found a significant drop in mortality among robotic lobectomy patients compared to video-assisted lobectomy patients.

The jury is still out on whether one minimally invasive technique is superior to the other, and it will be a point of contention for some time. But over the years, we are certainly seeing growing acceptance of robotic-assisted thoracic surgery as an effective surgical treatment for lung cancer patients.

At the University of Chicago Medicine, all our thoracic surgeons are skilled robotic surgeons with extensive experience in lung cancer removal.

The leading-edge technology we have in place at the University of Chicago Medicine not only serves as a platform to perform robotic lung cancer surgery but to develop and refine these surgical techniques for more and more indications in thoracic surgery, not just lobectomies and resections.

The indications have broadened and include staging procedures and complex resections of lobar and mediastinal pathology. The potential applicability is made on an individual patient basis.

As my colleagues and I continue proctoring and spearheading new initiatives, we want to take advantage of our position as early adapters of the robot to create and drive new opportunities for these systems to be applied in complex lung cancer cases.

Role of Genomic Markers in Lung Cancer

The widespread prevalence of NSCLC coupled with the lack of chemotherapeutic agents poses a dire situation. Analysis of genomic markers has vastly improved our understanding of NSCLC, allowing physicians to catch lung cancer earlier and offer treatment therapies that more effectively target specific genetic mutations.

For instance, individuals with mutations in epidermal growth factor receptor and the anaplastic lymphoma kinase gene respond well to tailored therapies.[KMG1]

Our surgical, oncological and radiological experts collaborate constantly to decide the best way to treat each individual’s cancer and consider the patient’s ability to tolerate various treatment modalities.

Despite our progress, as physicians, we know that cancer is a terribly complicated disease and every patient requires a comprehensive and tailored approach to their care. Robot-assisted thoracic surgery, though still developing, holds great promise for some of our sickest patients. This approach, in conjunction with comprehensive care has the potential to revolutionize the surgical care of lung cancer patients.

If you have any questions regarding lung oncology care at the University of Chicago Medicine, please call us at 773.795.3707

Christopher Wigfield, MD, is an Assistant Professor of Surgery and Surgical Director of the Lung Transplant Program at the University of Chicago Medicine. An expert in adult thoracic surgery and lung transplantation, he cares for patients with a wide range of cardiothoracic diseases, including lung cancer, mediastinal and pleural conditions, as well as chest wall tumors and defects.

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