How long from diagnosis of lung cancer to surgery

Surgery involves removing part of or the entire lung. Prepare for surgery by watching the What to Expect video above and using this worksheet to stay organized. Thoracotomy This is an incision on the side of the chest and follows the curve of your ribs. It typically involves dividing some of the muscles of the chest wall and uses an instrument to gently spread between two ribs to provide the surgeon access to the lung.

The muscles are repaired when the incision is closed. Minimally invasive surgery This approach typically involves 1 to 4 small incisions to access the inside of the chest.

The surgeon uses a camera to visualize the lung and special instruments to perform the surgery. This is known as thoracoscopy or video-assisted thoracoscopic surgery VATS and can also be done with the assistance of a surgical robot.

Types of Procedures Lobectomy The right lung is divided into three lobes; the left lung has two lobes. Lobectomy is the removal resection of the lobe of the lung affected by lung cancer.

This is the most commonly performed lung cancer surgery. A bilobectomy is the removal of two lobes and is only done for tumors of the right lung where the tumor involves two adjacent lobes. This can result in a right upper and middle bilobectomy or a right middle and lower bilobectomy.

A lung cancer surgery called a sleeve lobectomy is also sometimes done. These tumors typically involve one lobe as well as the main bronchus to that lung. A sleeve resection starts with the removal of the cancerous lobe and a portion of the main bronchus to that lung.

The remaining end of the main bronchus is then rejoined with the bronchus to any unaffected lobe s. When done a sleeve lobectomy avoids the need for a pneumonectomy see below. Segmentectomy Each lung lobe is made up of two to five lung segments. Surgeons can remove one to four segments of certain lobes and save uninvolved tissue.

Wedge Resection A wedge resection is the removal of a small, wedge-shaped part of the lung tissue surrounding the cancerous tumor. Pneumonectomy Pneumonectomy is the removal of the entire lung affected by cancer. This lung cancer procedure is usually done if the cancer cannot be fully removed with the lobectomy or if the lesion is centrally located.

You might experience: Pain Possible complications from the lung cancer surgery Discuss concerns, possible side effects and any effects that you experience with your surgeon. Sleeve resection Surgery to remove a lung tumor in a lobe of the lung and a part of the main bronchus airway. Next: Manage Side Effects. Among patients who met inclusion criteria Table 1 , the mean SD age was According to the traditional CTTS definition, patients Most veterans underwent lobectomy patients [ Histological results revealed that most patients had adenocarcinomas patients [ At 30 days, patients had died 2.

Additional demographic and perioperative variables are shown in Table 1. Pathologic upstaging occurred in patients Factors associated with higher odds of upstaging included younger age odds ratio [OR] for every 1-year increase in age, 0. Factors associated with higher odds of positive surgical margins included wedge resection OR vs lobectomy, 2.

Restricted cubic spline functions did not reveal a significant association between RTTS and the likelihood of upstaging or a resection with positive margins. With median IQR follow-up of 6.

Factors associated with increased risk of recurrence included younger age hazard ratio [HR] for every 1 year increase in age, 0. Based on the spline analysis, the risk of recurrence increased after approximately 12 weeks of delay Figure 2. To understand factors associated with surgical procedures delayed longer than 12 weeks, multivariable logistic regression analysis was performed Table 2.

Factors associated with delayed surgical treatment included African American race OR vs White race, 1. Patients receiving surgical treatment within 12 weeks of diagnosis had significantly better overall survival compared with patients who had treatment delayed more than 12 weeks HR, 1.

Finally, a sensitivity analysis was performed to assess whether CTTS was associated with recurrence eFigure 3 in the Supplement. We found that CTTS was not associated with increased risk of recurrence when using this definition in the spline modeling.

This cohort study examined the association of delayed surgical treatment with oncologic outcomes in patients in the VHA with clinical stage I lung cancer. Using a more robust and precise method for quantifying surgical delay ie, RTTS , our study found that patients who waited more than 12 weeks for resection had an increased risk of recurrence.

There was no association between delayed surgical treatment and the likelihood of pathologic upstaging or resection with positive margins. These findings suggest that while patients with clinical stage I lung cancer should continue to undergo expedient resection, there may be only a modest biologic penalty associated with short-term delays ie, those less than 3 months if additional workup or optimization are required.

Our findings fill an important gap in the medical literature and overcome some of the limitations of previous publications, including those from our own group. Based on the shape of these models, we found that surgical procedures delayed beyond 12 weeks had a significantly higher risk of recurrence.

Furthermore, with access to detailed VHA data and by using validated methods, 21 , 28 , 29 we were able to examine the risk of cancer recurrence, an outcome that is not available in most other large cancer databases, such as the NCDB.

This is a more specific oncologic outcome than overall survival and is critical to consider in the context of treatment delays. Most prior publications about delayed surgical treatment have analyzed single-institution or NCDB data. Patients can be diagnosed by any combination of imaging results, symptoms, clinical judgement, pathology, and cytology, and this diagnosis can even be changed in retrospect by the coders.

Therefore, analyzing this variable in these databases, even after excluding those patients with no documented wait time, is potentially flawed. It is worth noting that veterans appear to wait longer for surgical treatment than the general population.

According to the CTTS definition even though it is flawed , patients waited a mean of Yang and colleagues 7 performed an analysis of patients in the NCDB with clinical stage Ia squamous cell carcinoma who were undergoing lobectomy.

The median wait time to surgical treatment was 38 days 5. While this discrepancy warrants further study, veterans appear to have a high comorbidity burden while maintaining similar rates of short-term complications as the general population. If comorbidities are the driving factor associated with delays, then marginally delayed surgical procedures seem acceptable and likely necessary. Timely surgical treatment has been proposed as a quality metric for lung cancer care.

However, there are several caveats to including a week period as a proposed quality measure. Timely surgical treatment depends on several disease-specific and patient-specific factors. Additionally, as our study noted, several socioeconomic factors are associated with timeliness of care. Many of these variables remain nonmodifiable in the short interval between lung cancer diagnosis and surgical treatment, and treating institutions should not incur a penalty for factors outside their control.

Our study has some important strengths. First, we have assembled a relatively uniform population of patients with lung cancer, with veterans having access to universal health care coverage under the VHA. This eliminates confounding due to insurance-related factors previously noted to be associated with timely care. Finally, our data provide particularly timely information regarding delayed medical care, a common issue during the ongoing COVID pandemic.

Our study also has some limitations. First, our method for quantifying surgical delay based on the date of CT imaging may be imperfect. Because lung cancers have heterogeneous CT findings, our study results do not provide information on how quickly to proceed when dealing with indeterminate imaging findings. Second, our study assesses pathologically confirmed cases of NSCLC, but definitive pathologic confirmation is often unavailable preoperatively, especially for clinical stage I disease.

The decision to proceed to surgical treatment as opposed to continued surveillance can be complex, especially with smaller lung nodules, which can challenge the utility of time to treatment standards in real-world practice. Our data rather suggest that for highly suspicious nodules consistent with clinic stage I disease and certainly those with preoperative confirmatory pathology , surgical treatment within at least 12 weeks of radiographic diagnosis is prudent.

Third, our study consisted exclusively of a veteran population. While this cohort is not uniformly comparable to the overall US population, the general patterns of lung cancer care and outcomes are similar between veterans and nonveterans. These findings suggest that veterans with clinical stage I lung cancer who wait more than 12 weeks for resection may have an increased risk of recurrence and worse survival rates. Efforts to minimize delays in surgical procedures for lung cancer are essential to decrease the risk of disease recurrence and the associated worse prognosis.

New Patients and Healthcare Professionals can submit an online form by selecting the appropriate buttonbelow. Existing patients can call Click here for a current list of insurances accepted at Moffitt. Moffit now offers Virtual Visits for patients.

If you are eligible for a virtual appointment, our scheduling team will discuss this option further with you. Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health.

If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them. Common post-treatment problems include pain, fatigue, and shortness of breath. Your doctor, nurse, and social worker can help you develop a plan to manage any problems that persist after treatment.

People who have smoked cigarettes in the past also have a high risk of heart disease, stroke, emphysema, and chronic bronchitis. Certain cancer treatments can further increase these risks. You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional.

This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.