The treatment of lung cancer has shifted towards less invasive surgery and more precise therapies due to the impressive technologic improvements and the development of new oncologic agents and strategies. The interaction between advanced surgical technology and innovative medical treatments and their impact on lung cancer population are generating an unprecedented sequence of consequences and changes of perspective in all the surrounding fields: endoscopy, anesthesiology, radiology, biology and anatomopathology. From bench research to quality-of-life assessment, the opportunities and the outcomes yielded by minimally invasive surgery and modern precision medicine are affecting the way of constructing trials, selecting patients, retrieving biological material, performing radiological exams, controlling post-surgical pain, conducting post-operative courses, timing treatments, just to mention few, in a domino-effect that often runs in both directions.
Minimally invasive approaches including all techniques (Video-Assisted Thoracoscopy, Robotic Surgery, enhanced Bronchoscopy) allow to obtain excellent results in terms of oncological, functional and recovery outcomes in early stage lung cancer. Furthermore, also in locally advanced stages, expert surgeons can offer selected patients complex bronchial and vascular resections and reconstructions. The association of this minimally invasive surgery with modern oncological therapies is constantly improving long-term outcomes of lung cancer patients and recent trials focused on induction immunotherapy are globally revealing a significant positive trend promising to downstage a large amount of patients that could be fit for surgery at a low cost in terms of adverse events and loss in performance. A surgical strategy is therefore capable of reducing hospitalization and undesired sequelae is helpful. All the increasingly popular ERAS (Enhanced Recovery After Surgery) projects and guidelines fits in this scenario and involve different professional figures including anesthesiologists, specialized nurses and physiotherapists.
Redo surgery constitutes another huge part of this relatively new universe revolving around minimally invasive surgery. Overall prolonged survival, more precise and effective diagnostic tools, wider ranges of lines of treatments, the increasing need (driven by the requirements of novel oncological treatments) for tissue samples and re-samples and globally fitter patients, as a consequence of all of the above are the reasons for a growing number of re-interventions, often on patients already treated with multimodal protocols. Guaranteeing these patients a minimal surgical impact as well as leaving as few surgical “footprints” as possible is due and represent both an indication for and a virtuous effect of minimally invasive surgery. Nonetheless, whenever surgery is not an option, endoscopists are called to fill the gap: echoendoscopic procedures, both endobronchial and endoesophageal - even combined radiologically or GPS-guided computed endobronchial navigation are expanding techniques capable of mediastinal, pulmonary and sub-diaphragmatic minimally invasive assessment, allowing histologic and molecular characterization, staging, re-staging and re-sampling of thoracic malignancies.
The aim of this Research Topic is to investigate how the combination and the evolution of minimally invasive thoracic surgery, new oncological therapies (in all forms) and associated disciplines has changed the daily practice (and in a certain way, the composition either) of thoracic teams, how all this could increase the long term survival of lung cancer patients and what are the future perspectives for surgeons, oncologists, surrounding specialists and, finally, patients.
Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.
The treatment of lung cancer has shifted towards less invasive surgery and more precise therapies due to the impressive technologic improvements and the development of new oncologic agents and strategies. The interaction between advanced surgical technology and innovative medical treatments and their impact on lung cancer population are generating an unprecedented sequence of consequences and changes of perspective in all the surrounding fields: endoscopy, anesthesiology, radiology, biology and anatomopathology. From bench research to quality-of-life assessment, the opportunities and the outcomes yielded by minimally invasive surgery and modern precision medicine are affecting the way of constructing trials, selecting patients, retrieving biological material, performing radiological exams, controlling post-surgical pain, conducting post-operative courses, timing treatments, just to mention few, in a domino-effect that often runs in both directions.
Minimally invasive approaches including all techniques (Video-Assisted Thoracoscopy, Robotic Surgery, enhanced Bronchoscopy) allow to obtain excellent results in terms of oncological, functional and recovery outcomes in early stage lung cancer. Furthermore, also in locally advanced stages, expert surgeons can offer selected patients complex bronchial and vascular resections and reconstructions. The association of this minimally invasive surgery with modern oncological therapies is constantly improving long-term outcomes of lung cancer patients and recent trials focused on induction immunotherapy are globally revealing a significant positive trend promising to downstage a large amount of patients that could be fit for surgery at a low cost in terms of adverse events and loss in performance. A surgical strategy is therefore capable of reducing hospitalization and undesired sequelae is helpful. All the increasingly popular ERAS (Enhanced Recovery After Surgery) projects and guidelines fits in this scenario and involve different professional figures including anesthesiologists, specialized nurses and physiotherapists.
Redo surgery constitutes another huge part of this relatively new universe revolving around minimally invasive surgery. Overall prolonged survival, more precise and effective diagnostic tools, wider ranges of lines of treatments, the increasing need (driven by the requirements of novel oncological treatments) for tissue samples and re-samples and globally fitter patients, as a consequence of all of the above are the reasons for a growing number of re-interventions, often on patients already treated with multimodal protocols. Guaranteeing these patients a minimal surgical impact as well as leaving as few surgical “footprints” as possible is due and represent both an indication for and a virtuous effect of minimally invasive surgery. Nonetheless, whenever surgery is not an option, endoscopists are called to fill the gap: echoendoscopic procedures, both endobronchial and endoesophageal - even combined radiologically or GPS-guided computed endobronchial navigation are expanding techniques capable of mediastinal, pulmonary and sub-diaphragmatic minimally invasive assessment, allowing histologic and molecular characterization, staging, re-staging and re-sampling of thoracic malignancies.
The aim of this Research Topic is to investigate how the combination and the evolution of minimally invasive thoracic surgery, new oncological therapies (in all forms) and associated disciplines has changed the daily practice (and in a certain way, the composition either) of thoracic teams, how all this could increase the long term survival of lung cancer patients and what are the future perspectives for surgeons, oncologists, surrounding specialists and, finally, patients.
Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.
