Would you recommend lung cancer surgery on an 80 year old with non-small cell lung cancer who is in good health? What type of surgeon should do this procedure? What steps would you recommend for the most aggressive approach? How can a non-oncologist be knowledgeable enough to perform such an intense surgery?
Charles B. Simone II, MD, Radiation Oncologist at Penn Medicine, responds:
Without knowing the details of this particular case, I cannot make any definite recommendations. However, in general, surgery is the treatment with the greatest chance of curing non-small cell lung cancer. Thus, all patients with newly diagnosed non-small cell lung cancer, regardless of their age, should ideally be evaluated by a surgeon to determine if they are a candidate for surgical resection. Studies have shown that the risk of morbidity and even dying from surgery are higher for patients over the age of 70, typically because older patients have more medical problems other than lung cancer, poorer lung function, or are otherwise less able to tolerate surgery and the perioperative recovery. That is why all patients being considered for surgery should undergo a comprehensive preoperative work-up that includes: 1) pulmonary function tests to make sure the patient has enough lung function to remove part of the lung and still be able to breathe well, 2) PET/CT scan to evaluate for metastatic disease outside of the chest, and 3) brain MRI to evaluate for metastatic disease to the brain. If a patient has any prior cardiac history, a cardiology evaluation and potentially also a stress test is likely necessary. After this work-up, if the tumor is in fact localized and the patient overall is healthy, surgery can be considered, regardless of the age of the patient.
Regarding who should do the surgery, lung cancer surgery is best performed by a cardiothoracic surgeon (sometimes referred to as a thoracic surgeon) with a special interest in lung cancer. Such surgeons are often referred to as "general thoracic surgeons" or "non-cardiac thoracic surgeons." Surgeons who are board certified in "Thoracic Surgery" have had extensive training specifically in lung cancer surgery. General surgeons, surgical oncologists, and cardiac surgeons who are not board certified in Thoracic Surgery also perform lung cancer surgeries, but they may have less experience in those surgeries than a dedicated thoracic surgeon.