History
A male patient in his 60s with a prior history of smoking had been undergoing surveillance, low-dose CT lung cancer screenings. In May 2023, he was found to have new lung nodules concerning for lung cancer.
The patient’s CT showed enlarging and progressively solid ground-glass opacities (GGO) that were concerning for possible malignancy. Most notable was an enlarging 2.8 x 2.0 cm right upper lobe, sub-solid nodule with a new 4-mm component, along with an additional right upper lobe 1.3 x 1.0 cm sub-solid nodule, which has increased from 1.1 x 1.9 cm.
Presentation and Examination
Given the character and location of the nodules, a lobectomy was deemed necessary for resection. The patient was referred to James Katsis, MD, an interventional pulmonologist, for a robot-assisted bronchoscopy for diagnostic purposes of the suspected cancerous tissue.
After the bronchoscopy was performed via the Ion endoluminal system, it was confirmed that the patient had an invasive T1aN0 lung adenocarcinoma.
Once the diagnosis was confirmed, Michael Liptay, MD, a thoracic surgeon, performed a thoracoscopic right upper lobe lobectomy and mediastinal lymph node dissection under the same anesthetic. The margins were negative for tumor, and there was no evidence of lymphovascular invasion. The visceral pleura was uninvolved, and all lymph nodes were negative for neoplasm. The pathologic stage of the tumor was pT1a N0.
Outcome
The patient did well postoperatively and will not require additional treatment. He will return in six months to initiate surveillance imaging and monitor additional known lung nodules and GGOs.
Analysis
Shortened treatment time through multidisciplinary approach
In 2020, 2.2 million patients were diagnosed with lung cancer worldwide, and 1.8 million patients died. According to the American Cancer Society, 238,340 new cases of lung cancer and 127,070 lung cancer deaths are expected in 2023 in the U.S. alone. Per current National Comprehensive Cancer Network guidelines, a typical lung cancer patient should go from diagnosis to treatment within eight weeks. Delayed time to treatment can adversely affect progression of the disease.
The ability to minimize upstaging and the need for adjuvant therapy is greatly enhanced with a timely diagnosis combined with a quick treatment turnaround. If clinicians can shorten the time from diagnosis to treatment from weeks to minutes, we are likely to cure more cancer.
This approach is contingent on utilizing a coordinated, multidisciplinary approach between the anesthesia, pathology, pulmonology and thoracic surgery teams. Effective communication is critical between these groups to facilitate both the bronchoscopy and lobectomy under the same anesthetic.
Move to more minimally invasive surgery
Treatment plans utilizing the same anesthesia for multiple procedures streamline the experience for our patients. In addition, robot-assisted procedures, such as the use of the Ion endoluminal platform in this case, give pulmonologists access to all 18 segments of the lung and enhance their precision and stability to target specific nodes for biopsy.
