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