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Guidelines Call for Board-Certified Thoracic Surgeon With Cancer Expertise in NSCLC: Presented at NCCN By Ed Susman HOLLYWOOD, Fla -- March 14, 2010 -- Not just any surgeon, nor any chest surgeon, should be involved in surgical operations involving removal of non-small-cell lung cancer (NSCLC), said doctors here at the 15th Annual National Comprehensive Cancer Network (NCCN) Conference on Clinical Practice Guidelines and Quality Cancer Care. For the first time, the “Principles of Surgery” statement that is part of the guidelines for treatment of non-small-cell lung cancer says: “Surgical staging and pulmonary resection should be performed by board-certified thoracic surgeons who perform lung cancer surgery as a prominent part of their practice.” In the treatment guidelines -- presented here on March 13 by David Ettinger, MD, Johns Hopkins University, Baltimore, Maryland -- the need for the specialised surgeon is mentioned twice. Once for surgical staging and pulmonary resection and also to determine if resection should be performed at all. “Thirty years ago you would have had a surgical oncologist who operated from ‘stem to stern,’ so to speak, but that has changed now,” Dr. Ettinger said as he outlined numerous changes in the treatment algorithm. A key part of the algorithm is the status of tumour margins, hence the need for thoracic oncology surgical expertise. The guidelines suggest that in sublobar resection: “Segmentectomy and wedge resection should achieve parenchymal resection margins that are at least 2 cm or at least the size of the nodule. Sublobar resection should also sample appropriate N1 and N2 lymph node stations unless not technically feasible without substantially increasing surgical risk.” The guidelines suggest use of segmentectomy in cases in which the patient may have poor pulmonary reserve or other comorbidity that precludes lobectomy. “The overall plan of treatment as well as needed imaging studies should be determined before any non-emergency treatment is initiated,” the Principles of Surgery states. “Thoracic surgeons should actively participate in multidisciplinary discussions and meeting regarding lung cancer patients.” Dr. Ettinger noted that the new principles of surgery recommend that: · Resection, including wedge resection, is preferred over ablation (radiofrequency ablation, cryotherapy, or stereotactic radiation). · Thoracic surgical oncology consultation should be part of the evaluation of any patient being considered for curative local therapy. · Anatomical pulmonary resection is preferred for the majority of patients with non-small-cell lung cancer. [Presentation title: NCCN Non-Small Cell Lung Cancer Guidelines Update] E-mail this page to a friend or colleague! To print, use this version