Early-stage lung cancer patients are frequently treated, and often cured, with surgery. Over the past 15 years, new technologies have made surgical outcomes for early-stage lung cancer even better. Jessica Donington, MD, a thoracic surgeon at NYU Langone Medical Center and a LUNGevity Scientific Advisory Board member, uses these techniques and knows their value firsthand.
Technological developments in lung cancer surgery have given Dr. Donington more options for helping her patients. In particular, she cites minimally invasive surgical techniques as being key advancements in the field. Around 2005, she says, lung cancer surgeons started performing video-assisted lung resections for cancer. When performing these techniques, surgeons don’t make a large cut through the chest wall to gain access to the lungs. Instead, they thread thin surgical instruments through small incisions and use the help of a tiny camera to remove the tumor. This helps patients avoid the long recovery resulting from a surgeon cutting the large muscles of the chest wall and spreading the ribs. The minimally invasive techniques improved long-term survival rates and the surgeries were better tolerated by elderly patients. Today a surgical robot can also be used to guide the surgery through small incisions, improving the surgeon’s dexterity inside the chest.
“Sometimes tumors are too big, or they involve important structures and surgeons don’t have a choice,” she notes. “But more and more, early-stage lung cancer is being treated with minimally invasive surgeries.” She estimates that approximately 35% to 45% of lung cancer resections are performed this way now, and she expects that percentage to increase over the next couple of decades.
Another exciting advancement in the field is EBUS, or endobronchial ultrasound, a less invasive way to biopsy key lymph nodes around the windpipe without surgery, in order to diagnose stage III lung cancer. Typically, stage I and stage II lung cancers are treated first with surgery, after which a patient may receive chemotherapy if needed. If the cancer has spread to the mediastinal lymph nodes (those around the windpipe) the cancer is considered locally advanced, or stage III, and the initial treatment plan shifts to starting with chemotherapy. Now, doctors can avoid cutting the patient for the biopsy and instead do an outpatient procedure using an ultrasound with a bronchoscope.
Overall, the future of lung cancer surgery looks bright for early-stage lung cancer patients, says Dr. Donington. “I think it is possible that in 20 years, no one will have open-chest surgery for lung cancer anymore.”
Dr. Donington also discussed the exciting potential for the use of checkpoint inhibitors, drugs that enhance the body’s own immune system to fight cancer, in combination with surgery. “This new class of drugs is revolutionizing the treatment of stage IV lung cancer,” says Dr. Donington. “I am so excited that researchers are looking at what these drugs may be able to do for patients at earlier stages. Combining these drugs with surgical resections could turn out to be powerful.”
Dr. Donington notes that funding lung cancer research through organizations like LUNGevity is critical for continued progress in the field. She also expects that LUNGevity’s patient and caregiver advocacy programs will continue to play an important role in the years to come.
“I envision a future where lung cancer research is well funded, the stigma associated with the disease is erased, and lung cancer patients are fully supported with a host of treatment options and services,” says Dr. Donington. “I think if we work together, we can get there.”
Juhi Kunde, MA, is a science writer for LUNGevity.