Dr Chudgar on Defining Resectability in NSCLC

Neel P. Chudgar, MD, assistant professor, Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine; thoracic surgeon, associate director, Clinical and Translational Research, Thoracic Surgery, attending physician, Montefiore Medical Center, discusses his presentation on resectability in non–small cell lung cancer (NSCLC) at the 21st Annual Winter Lung Cancer Conference®.

The presentation titled 'What is the Definition of Resectability?' delved into the rationale behind exploring this concept and examined the current controversies surrounding it, Chudgar begins, adding that crafting this presentation proved challenging due to the abundant controversies within this space. While considering the definition of resectability, factors such as patient-related medical operability were relatively less contentious, thus not extensively covered. However, emphasis was placed on technical aspects, evaluating whether a tumor could be safely and effectively removed, along with assessing oncologic factors crucial for a patient's overall outcome, Chudgar reports. Despite efforts to focus on these aspects, data remains limited, hindering the establishment of definitive guidelines regarding resection for specific disease stages or patient profiles, he notes

Regarding the consideration of surgery for patients with clinical T4 disease, the Albert Einstein College of Medicine conducted a study utilizing the National Cancer database, Chudgar expands. This analysis revealed instances where tumors clinically classified as T4 were found to be non-T4 upon surgical exploration. This discrepancy suggests a potential overestimation of tumor invasion preoperatively, he adds, noting that in clinical practice, physicians may be more cautious and not operate on a clinically classified T4 tumor, even though some of these tumors may not actually reach this threshold. However, the study demonstrated the feasibility and safety of resection for such patients, evidenced by favorable outcomes such as low 30- and 90-day mortality rates and promising remission rates, Chudgar reports.

Furthermore, the study underscored the safety of minimally invasive resection procedures, indicating that this type of surgery can be conducted safely with reasonable survival rates, Chudgar continues. These findings provided valuable insights into the considerations surrounding surgical interventions for patients with clinical T4 disease, emphasizing the importance of accurate preoperative assessment and the potential benefits of minimally invasive approaches in ensuring patient safety and favorable outcomes, Chudgar concludes.