Latest news with #thoracicsurgery
Medscape
26-06-2025
- Health
- Medscape
It's Complicated: Surgery and Lung Cancer Care
This transcript has been edited for clarity. Hello. It's Mark Kris from Memorial Sloan Kettering, continuing my little series on the initial treatment of patients with lung cancers. In the earlier discussions, we talked about people with metastatic disease. I'd like to switch today to talking about people who are candidates for surgery. The two operant terms here are operable and resectable. Operable means that the patient is medically fit to have an operation and to undergo the extent of surgery needed for a complete resection. Resectable means that, in the opinion of the thoracic surgeon who will be performing the surgery, R0 resection is likely to be achieved. Again, these things are not perfect. Experience guides many of our decisions here, and the operative decision is made by many different folks. The surgery decision really needs to be made by a surgeon. The truth is that the question of resectability comes from the surgeon at your institution, in your multidisciplinary tumor board. What are the stages we're talking about? Looking at the trials of perioperative therapies, the stages looked at are IB (tumors greater than 4 cm, regardless of nodal status) up to IIIB (larger primary tumors with N2 nodes). N3 nodes are a different discussion, which we'll hopefully have later on. I think I personally am unbelievably struck by the amount of data and the absolute consistency of data about the use of neoadjuvant therapy in patients who do not have a driver. That's the first group I'd like to address. It is critical to get sufficient tissue to make sure that there are no drivers present. If you have a driver, particularly EGFR and ALK , it sends you in a different direction for decision making. Also, if you're following the package insert, for example, you need to show that the patients are EGFR and ALK negative. To do that, you really should do next-generation sequencing in 2025. It has to be done on tissue. The data from using blood in these situations show that less than [about] one in five of the mutations are detected in blood in these earlier-stage patients. You must have tissue. Obviously, if you have a positive blood test, that's great. You can use it. If it's negative, though, you must have tissue. You have to get the tissue, you have to get the answer, and you have to get it quickly. It's not an easy situation, and we can talk about that. I think the data are very, very clear in the nine trials now. There are nine randomized trials that have been reported, and every single one shows an improvement in disease-free survival by giving neoadjuvant therapy with chemotherapy and a checkpoint inhibitor. I'm struck by the consistency of the trials, by the huge amount of data, and I think that makes this the standard of care today in patients that are both operable and resectable. What about the discussions that go on at our tumor boards about the need for immediate surgery, particularly for sick patients with IB and II disease? Well, I have to say that there are virtually no data for the patient sitting in your office, saying that immediate surgery followed by adjuvant therapy is as good, or better than, the neoadjuvant approach. Frankly, there probably is never going to be a trial that answers that. When you look at the trials of where people have proposed to do adjuvant therapy, up to one-third of the patients, or more, never get the adjuvant therapy. It's really an apples-and-oranges comparison here. The data just do not exist and I think are unlikely to exist just by the nature of the problems. For people who have neoadjuvant therapy, there are two groups now as well. There are patients who have a major response, particularly a pathologic complete response or no pathologic response, and there are patients who don't. I think for those who don't, the way forward is clear. You need an alternative therapy. I personally would advise not to give a component of the neoadjuvant program that was truly unsuccessful, particularly for folks who have a large amount of remaining disease in the resection specimen. For people with no pathologic response or a pathologic complete response, the question there comes whether to give perioperative therapy, generally the checkpoint inhibitor, after or not. The data here are, again, not going to give you the answer. The trial of nivolumab — not followed by a year of nivolumab after surgery — showed very, very good results and really comparable to those results. The FDA has clearly pointed out that the data supporting the use of the additional year of therapy with the checkpoint inhibitor are not proven. There is toxicity. In adjuvant situations, the data are not particularly impressive. I do want to point out the need for consideration of postoperative therapy with radiation if you have N2 disease. When you look at the recurrences noted in the neoadjuvant and adjuvant trials, now with better systemic therapy, the recurrences are in the chest. We must think about improving control in the chest. Frankly, the only modality we have today to do that is radiation, and it's most proven for N2 disease. I do think it's very, very important for people with N2 disease to get a radiation oncologist in the treatment planning group to see if there is a role for radiation in those patients. To summarize, I think for patients who don't have a driver and are operable and resectable, neoadjuvant is the way to go. What you do afterward is difficult for people with a major pathologic response. You can make a good case for not giving any additional therapy. There are FDA-approved regimens to give additional therapy of the same drugs. For people who clearly progress, you need to think about what other alternatives there are, both local and systemic.
Arab News
30-05-2025
- Health
- Arab News
King Abdullah Medical City in Makkah pioneers first robotic thoracic surgery with Da Vinci system
MAKKAH: King Abdullah Medical City in Makkah has successfully performed the first precise robotic thoracic surgery using the Da Vinci Xi system. Dr. Adel Tash, CEO of KAMC, told Arab News that the launch of the service is a significant medical milestone, further solidifying the city's role as a leading reference center for advanced specialized healthcare, driven by the latest innovations in medical and surgical technology. 'The first case involved a patient in his thirties who suffered from recurrent air accumulations in his left chest cavity, causing persistent breathing difficulties. Tests revealed cysts in the upper and lower lobes of his left lung. These cysts were successfully removed, and the lung was attached to the chest wall using a surgical robot during a delicate operation that took an hour and a half,' Tash said. The operation was performed under the leadership of Dr. Muteb Al-Zaidi, a consultant in thoracic, esophageal, and gastric surgery, using robotic and minimally invasive endoscopic techniques. He was assisted by Dr. Ayman Jaafar, assistant consultant in thoracic surgery, in collaboration with a specialized team from the anesthesia and nursing departments. Tash said robotic surgery is characterized by the high precision provided by the 3D camera, and the ability to precisely access complex areas of the body with minimal intervention, which is reflected in reduced post-operative pain, accelerated recovery, and faster discharge of the patient from the hospital compared with traditional operations. He said that traditional operations required surgical incisions that could be more than 10 centimeters whereas a single incision in robotic surgery does not exceed 1 cm, which reduces side effects and improves overall surgical outcomes. Tash concluded by underscoring KAMC's ongoing commitment to adopting the latest scientific technologies and providing advanced and safe healthcare services that contribute to improving patients' quality of life and making the treatment experience a model to be emulated across the Kingdom and the region. In this context, KAMC, a member of the Makkah Health Cluster, launched the Da Vinci surgical system, positioning itself among the first healthcare institutions in the Western Region to adopt this state-of-the-art technology for intricate and high-precision surgeries. This step is expected to enhance the quality of medical services and elevate the patient experience, aligning with the goals of the Kingdom's Vision 2030. The Da Vinci system is a robotic platform that allows surgeons to perform complex procedures with exceptional precision. Operated from a central console, the system translates the surgeon's hand movements into highly refined, microscopic actions, enhanced by a high-definition, magnified 3D view of the surgical site. It comprises three key components: the surgeon console, where the surgeon directs the procedure via an advanced visual interface; the patient cart, which houses robotic arms equipped with surgical instruments and a high-resolution camera; and the vision cart, responsible for image transmission and visual processing. Crucially, the system is not autonomous. The entire operation is performed under the full control of a surgeon. The system was first used at KAMC in a thoracic surgery, followed by a complex procedure for a patient with uterine cancer. The surgery was completed without complications, and the patient was discharged in less than 24 hours. KAMC now plans to expand the system's use to a wide range of specialties, including urology, gastrointestinal surgery, thoracic and cardiac procedures, bariatric surgery, and other advanced general surgeries. The system offers a range of technical and medical advantages, including high-definition 3D visualization that allows surgeons to observe intricate anatomical details with exceptional clarity; ultra-precise instrument control that mimics the natural movement of the human hand with microscopic accuracy; and minimally invasive procedures through small incisions, which significantly reduce pain, blood loss, and the risk of infection. Patients benefit from faster recovery times, shorter hospital stays, and improved surgical outcomes with lower complication rates compared with traditional surgery. Additionally, the system supports advanced surgical education and training through a safe, highly accurate simulation environment. KAMC seeks to broaden the application of robotic surgery across additional subspecialties, advance physician training through immersive virtual reality simulations, and use smart analytics and artificial intelligence to elevate the precision, efficiency and overall quality of surgical outcomes.
