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Life
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Surgical Treatment and Outcomes of Lung Cancer
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Surgical Treatment and Outcomes of Lung Cancer

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 11294

Special Issue Editor

Dr. Domenico Galetta

E-Mail Website
Guest Editor
Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
Interests: NSCLC; SCLC; surgery; induction therapy; radiation therapy; EBUS; robotic; VATS; locally advanced NSCLC; immunotherapy; target therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lung cancer is the leading cause of cancer death and is a major worldwide health problem. Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC) remain extremely aggressive tumors with a dismal prognosis. Nonetheless, significant progress is being made in preventing and treating lung cancer.

The last decade has seen important advances in the diagnosis and treatment of lung cancer: large screening program for the detection of early-stage NSCLC, new tools for the diagnosis of lung cancer, advances in surgical approaches, and the use of new surgical techniques for the treatment of both early or locally advanced NSCLC and new therapeutical approaches for advanced lung cancer (the so called “personalized therapy”, including targeted therapies and immunotherapies). All of these advances have led to important improvements in surgical outcomes and long-term survival rates.

For this reason, this Special Issue of Life regarding “Surgical Treatment and Outcomes of Lung Cancer” would like to focus on the major advances in detection, diagnosis, treatments with curative intent, new diagnostic and therapeutic technologies and strategies, systemic targeted therapies, and feature topics concerning the treatment of both small cell lung cancer and non-small cell lung cancer.

We welcome all studies whose findings lead to a better understanding of this rapidly evolving field, offering readers future perspectives on diagnostic and therapeutic approaches.

Dr. Domenico Galetta
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • NSCLC
  • SCLC
  • surgery
  • induction therapy
  • radiation therapy
  • EBUS
  • robotic
  • VATS
  • locally advanced NSCLC
  • immunotherapy
  • target therapy

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Published Papers (6 papers)

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Research

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13 pages, 2282 KiB  
Article
Association between Mortality and Lung Low Attenuation Areas in NSCLC Treated by Surgery
by Davide Colombi, Ganiyat Adenike Ralitsa Adebanjo, Rocco Delfanti, Sara Chiesa, Nicola Morelli, Patrizio Capelli, Cosimo Franco and Emanuele Michieletti
Life 2023, 13(6), 1377; https://doi.org/10.3390/life13061377 - 12 Jun 2023
Cited by 1 | Viewed by 1315
Abstract
Background: to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC). Methods: patients who underwent radical surgery for NSCLC at our institution between [...] Read more.
Background: to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC). Methods: patients who underwent radical surgery for NSCLC at our institution between 1 January 2017 and 30 November 2021 were retrospectively evaluated. Patients who performed staging or follow-up CTs in other institutions, who received lung radiotherapy or chemotherapy, and who underwent previous lung surgery were excluded. At staging and 12-months follow-up CT, LAAs defined as voxels <−950 Hounsfield units, were extracted by software. The percent of LAAs relative to whole-lung volume (%LAAs) and the ratio between LAAs in the lobe to resect and whole-lung LAAs (%LAAs lobe ratio) were calculated. Cox proportional hazards regression analysis was used to test the association between OS and LAAs. Results: the final sample included 75 patients (median age 70 years, IQR 63–75 years; females 29/75, 39%). It identified a significant association with OS for pathological stage III (HR, 6.50; 95%CI, 1.11–37.92; p = 0.038), staging CT %LAAs ≥ 5% (HR, 7.27; 95%CI, 1.60–32.96; p = 0.010), and staging CT %LAA lobe ratio > 10% (HR, 0.24; 95%CI 0.05–0.94; p = 0.046). Conclusions: in patients with NSCLC who underwent radical surgery, a %LAAs ≥ 5% and a %LAA lobe ratio > 10% at staging CT are predictors, respectively, of shorter and longer OS. The LAA ratio to the whole lung at staging CT could be a critical factor to predict the overall survival of the NSCLC patients treated by surgery. Full article
(This article belongs to the Special Issue Surgical Treatment and Outcomes of Lung Cancer)
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9 pages, 383 KiB  
Article
Intraoperative Catastrophes during Robotic Lung Resection: A Single-Center Experience and Review of the Literature
by Beatrice Manfredini, Carmelina Cristina Zirafa, Gaetano Romano, Elena Bagalà, Claudia Cariello, Federico Davini and Franca Melfi
Life 2023, 13(1), 215; https://doi.org/10.3390/life13010215 - 12 Jan 2023
Cited by 2 | Viewed by 1725
Abstract
Background: Robotic surgery is increasingly used in the treatment of lung disease. Intraoperative catastrophes, despite their low incidence, are currently a critical aspect of this approach. This study aims to identify the incidence and management of catastrophic events in patients who underwent robotic [...] Read more.
Background: Robotic surgery is increasingly used in the treatment of lung disease. Intraoperative catastrophes, despite their low incidence, are currently a critical aspect of this approach. This study aims to identify the incidence and management of catastrophic events in patients who underwent robotic anatomical pulmonary resection; (2) Methods: Data from all patients who underwent robotic anatomical pulmonary resection from 2014 to 2021 for lung disease were collected and analyzed. Catastrophic intraoperative events are defined as events that demanded emergency management for life-threatening bleeding, with or without undocking and thoracotomy; (3) Results: Catastrophic events occurred in seven (1.4%) procedures; all of them consisted of vascular damage during lobectomy. Most of the catastrophic events occurred during left upper lobectomies (57%). Patients in this group had a higher ASA class and a higher pathological stage compared to the control group; (4) Conclusions: Intraoperative catastrophes are unpredictable events which also occur in experienced surgical teams. Given the widespread use of robotic surgery, it is essential to develop well-defined crisis management strategies to better manage catastrophic events in robotic thoracic surgery and improve clinical outcomes. Full article
(This article belongs to the Special Issue Surgical Treatment and Outcomes of Lung Cancer)
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9 pages, 1577 KiB  
Article
Software-Based Assessment of Well-Aerated Lung at CT for Quantification of Predicted Pulmonary Function in Resected NSCLC
by Davide Colombi, Camilla Risoli, Rocco Delfanti, Sara Chiesa, Nicola Morelli, Marcello Petrini, Patrizio Capelli, Cosimo Franco and Emanuele Michieletti
Life 2023, 13(1), 198; https://doi.org/10.3390/life13010198 - 10 Jan 2023
Cited by 2 | Viewed by 2058
Abstract
Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC [...] Read more.
Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC who underwent lobectomy or segmentectomy without a history of thoracic radiotherapy or chemotherapy treatment with the availability of PFTs at 12 months follow-up. Postoperative predictive (ppo) lung function was calculated using the resected lobe WAL (the lung volume between −950 and −750 HU) at sCT. The Spearman correlation coefficient (rho) and intraclass correlation coefficient (ICC) were used to the test the agreement between WAL ppo-PFTs and mpo-PFTs. Results: the study included 40 patients (68 years-old, IQR 62–74 years-old; 26/40, 65% males). The WAL ppo-forced expiratory volume in 1 s (FEV1) and the ppo-diffusing capacity of the lung for carbon monoxide (%DLCO) were significantly correlated with corresponding mpo-PFTs (rho = 0.842 and 0.717 respectively; p < 0.001). The agreement with the corresponding mpo-PFTs of WAL ppo-FEV1 was excellent (ICC 0.904), while it was good (ICC 0.770) for WAL ppo-%DLCO. Conclusions: WAL ppo-FEV1 and WAL ppo-%DLCO at sCT showed, respectively, excellent and good agreement with corresponding mpo-PFTs measured 12 months after surgery for NSCLC. WAL is an easy parameter obtained by staging CT that can be used to estimate post-resection lung function for patients with borderline pulmonary function undergoing lung surgery. Full article
(This article belongs to the Special Issue Surgical Treatment and Outcomes of Lung Cancer)
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11 pages, 1738 KiB  
Article
Baseline Ang-2 Serum Levels as a Predictive Factor for Survival in NSCLC and SCLC
by Asimina Nikolakopoulou, Dimitris Tsakogiannis, Flora Zagouri, Eleni Zografos, Lamprini Tzioga, Grigorios Stratakos, Nikolaos Koulouris, Konstantinos Syrigos and Garyfalia Bletsa
Life 2022, 12(12), 2092; https://doi.org/10.3390/life12122092 - 13 Dec 2022
Viewed by 1396
Abstract
Angiopoietin-2 (Ang-2) has been implicated in the development of several types of cancer, including lung malignancy. In the present study, we examined the impact of Ang-2 serum concentration on the development, dissemination, and 5-year overall survival of NSCLC and SCLC. A total of [...] Read more.
Angiopoietin-2 (Ang-2) has been implicated in the development of several types of cancer, including lung malignancy. In the present study, we examined the impact of Ang-2 serum concentration on the development, dissemination, and 5-year overall survival of NSCLC and SCLC. A total of 99 patients with lung cancer were tested. The OS of NSCLC and SCLC patients was estimated using Kaplan–Meier curves and compared through log-rank test. The median serum level of Ang-2 at baseline in both NSCLC and SCLC patients was significantly higher than that of controls (p < 0.0001). The Ang-2 serum concentration was not related to metastasis, neither in NSCLC nor in SCLC cases. The OS was found to be significantly shorter for stage IIIβ NSCLC patients with a high baseline Ang-2 serum concentration (p = 0.012), while Cox regression analysis showed that Ang-2 is a significant independent factor for poor prognosis for stage IIIβ NSCLC (hazard ratio = 2.97, 95% CI: 1.05–8.40, p = 0.04). The concentration of Ang-2 has no impact on the prognosis of SCLC. Ang-2 could be considered as a significant molecular marker that enables the prediction of NSCLC and SCLC development, and is involved in the poor prognosis of stage IIIβ NSCLC. Full article
(This article belongs to the Special Issue Surgical Treatment and Outcomes of Lung Cancer)
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Review

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13 pages, 616 KiB  
Review
The Clinical Significance of Circulating Tumor DNA for Minimal Residual Disease Identification in Early-Stage Non-Small Cell Lung Cancer
by Alberto Verlicchi, Matteo Canale, Elisa Chiadini, Paola Cravero, Milena Urbini, Kalliopi Andrikou, Luigi Pasini, Michele Flospergher, Marco Angelo Burgio, Lucio Crinò, Paola Ulivi and Angelo Delmonte
Life 2023, 13(9), 1915; https://doi.org/10.3390/life13091915 - 15 Sep 2023
Cited by 1 | Viewed by 1657
Abstract
Lung cancer (LC) is the deadliest malignancy worldwide. In an operable stage I–III patient setting, the detection of minimal residual disease (MRD) after curative treatment could identify patients at higher risk of relapse. In this context, the study of circulating tumor DNA (ctDNA) [...] Read more.
Lung cancer (LC) is the deadliest malignancy worldwide. In an operable stage I–III patient setting, the detection of minimal residual disease (MRD) after curative treatment could identify patients at higher risk of relapse. In this context, the study of circulating tumor DNA (ctDNA) is emerging as a useful tool to identify patients who could benefit from an adjuvant treatment, and patients who could avoid adverse events related to a more aggressive clinical management. On the other hand, ctDNA profiling presents technical, biological and standardization challenges before entering clinical practice as a decisional tool. In this paper, we review the latest advances regarding the role of ctDNA in identifying MRD and in predicting patients’ prognosis, with a particular focus on clinical trials investigating the potential of ctDNA, the technical challenges to address and the biological parameters that influence the MRD detection. Full article
(This article belongs to the Special Issue Surgical Treatment and Outcomes of Lung Cancer)
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10 pages, 249 KiB  
Review
Lung Segmentectomy in NSCLC Surgery
by Alberto Salvicchi, Simone Tombelli, Giovanni Mugnaini and Alessandro Gonfiotti
Life 2023, 13(6), 1284; https://doi.org/10.3390/life13061284 - 30 May 2023
Cited by 1 | Viewed by 2392
Abstract
Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are [...] Read more.
Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are elderly. In 1995, the Lung Cancer Study Group published the results of a randomized, prospective trial demonstrating the superiority of lobectomy compared with sublobar resection. From then on, wedge resection and segmentectomy were reserved exclusively for patients with poor functional reserve who could not tolerate lobectomy. Therefore, the exact role of segmentectomy has been controversial over the past 20 years. Recently, the randomized controlled trial JCOG0802/WJOG4607L demonstrated that segmentectomy was superior to lobectomy in patients with stage IA NSCLC (<2 cm and CTR < 0.5) in terms of both overall-survival and post-operative lung function. Based on these results, segmentectomy should be considered the standard surgical procedure for this patient group. In 2023, the randomized phase III CALGB 140503 (Alliance) trial demonstrated the efficacy and non-inferiority of sublobar resection, including wedge resection, for clinical stage IA NSCLC with tumor diameter of < 2 cm. This article is a narrative review of the current role of segmentectomy in lung cancer treatment and summarizes the most relevant studies in this context. Full article
(This article belongs to the Special Issue Surgical Treatment and Outcomes of Lung Cancer)
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