General Thoracic

Two STS 2024 sessions featured late-breaking research covering new findings on a research study focused on resectable early stage non-small-cell lung cancer and a study that used data to define characteristics associated with long-term survival following esophagectomy for cancer.

Impact of Surgical Factors on Event-Free Survival in the Randomized, Placebo-Controlled, Phase 3 KEYNOTE-671 Trial of Perioperative Pembrolizumab For Early Stage Non-Small-Cell Lung Cancer

In a talk given by presenting author Jonathan David Spicer, MD, PhD, of McGill University, he discussed new findings from the KEYNOTE-671 research study, focused on resectable early stage non-small-cell lung cancer (NSCLC), which have unveiled a significant breakthrough in the treatment landscape. 

The study, titled "Impact of Surgical-Related Data on Event-Free Survival in KEYNOTE-671," demonstrated that neoadjuvant therapy with pembrolizumab plus chemotherapy did not delay surgery. "Results showed that neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab provided meaningful improvement in EFS," said Dr. Spicer. "This was shown when compared with neoadjuvant chemotherapy alone for resectable early stage NSCLC – regardless of clinical nodal status, baseline disease stage, or type of surgery."

Longitudinal Follow-up of Elderly Patients After Esophageal Cancer Resection in the Society of Thoracic Surgeons General Thoracic Surgery Database

In this study, Justin Blasberg, MD, of Yale School of Medicine, used the STS General Thoracic Surgery Database linked to the Centers for Medicare and Medicaid Services data to define characteristics associated with long-term survival following esophagectomy for cancer. The analysis included 4,798 patients from 207 STS sites who underwent esophagectomy between 2012-2019. "The researchers found that Medicare patients undergoing esophagectomy for cancer exhibit identifiable predictors for long-term survival and readmission," noted Dr. Blasberg. "The absence of pathologic T and N downstaging increases the risk for long-term mortality and readmission."

These findings suggest opportunities to enhance clinical practice and improve outcomes for Medicare patients undergoing esophagectomy for cancer. 

The 2024 Lung Transplant Symposium: Surgical and Medical Insights for Transplant Assessment and Management, presented at the STS 2024 pre-conference convening on Friday, January 26. Approximately 100 surgeons, pulmonologists, anesthesiologists, and other transplant team members learned about best-practice approaches for surgical and medical care of lung transplant patients – from assessment as candidates though post-surgical care as recipients.

After a welcome and introduction by STS President Dr. Tom MacGillivray, Dr. Shaf Keshavjee of the Toronto Lung Transplant Program at the University Health Network, gave a brief overview of lung transplantation firsts and milestones before moving into present-day breakthroughs and areas of concern. 
  
"Current noteworthy topics we’re addressing in lung transplantation include primary graft dysfunction, donor management, and organ repair centers, refining the transplant ecosystem, as well as understanding the challenges of retrieval and transport of organs," said Dr. Keshavjeee.

Five 90-minute sessions covered the following subject areas: recipient selection, donor selection, intraoperative management, postoperative management, and challenging situations led by expert panels who answered questions from attendees.

Among the wide range of presentations, the Symposium featured included, "ECMO as Bridge to Transplant;" "Organ Procurement Techniques -- DBD, DCD, or NRP;" "Perioperative and Intraoperative Anesthesia Management;" and "Diagnosis, Monitoring and Therapeutic Challenges," which each cited current research and case study results.

In observance of Lung Cancer Awareness Month, STS participated in a congressional press conference focused on the importance of lung cancer screening hosted on the U.S. Capitol grounds on Thursday, November 16. The event, hosted by Congresswoman Kathy Castor (D-FL), aimed to bring attention to the urgent need to get more people screened for lung cancer. 

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STS joined other key stakeholders in the lung cancer community at this event, including LUNGevity Foundation, American Lung Association, GO2 for Lung Cancer, Moffitt Cancer Center, the Roswell Park Comprehensive Cancer Center, and Rep. Debbie Wasserman Schultz (D-FL).  

STS has a long history of advocating for robust patient access to lung cancer prevention, screenings, and treatment. “Over the past decade, significant progress has been made to expand insurance coverage of lung cancer screening, yet this press conference highlighted that significant challenges remain to increasing screening rates among at-risk individuals,” said Keith Mortman, MD, who participated in the press conference and is a member of the STS Workforce on Health Policy, Reform, and Advocacy. “While innovative treatments for lung cancer are rapidly emerging, not everyone has equal access to these cutting-edge treatments. STS is relentlessly advocating with policymakers in Washington to remove barriers and increase access so our members can offer the highest quality lung cancer care possible.”

To advance this priority, STS has advocated for H.R. 4286, Increasing Access to Lung Cancer Screening Act, a bipartisan bill introduced by Reps. Brian Higgins (D-NY), Brian Fitzpatrick (R-PA), and Kathy Castor (D-FL), that would require all state Medicaid programs to cover lung cancer screenings for eligible enrollees as recommended by the U.S. Preventative Services Task Force (USPSTF). Urge your lawmakers to support this legislation today.

Overall survival rates of esophageal cancer have risen in the past 50-plus years, from 5% in 1970 to 22% in 2023. Yet, no comprehensive guidelines addressing multidisciplinary management of esophageal cancer that incorporate input from surgeons, radiation oncologists, and medical oncologists have been available, until now. 

The Society of Thoracic Surgeons, American Society for Radiation Oncology, and American Society of Clinical Oncology have co-authored the first comprehensive guideline on the management of esophageal cancer. Published today in The Annals of Thoracic Surgery, the guideline addresses key clinical subject areas pertinent to the care of patients with locally advanced, resectable thoracic esophageal cancer. 

The guideline delivers recommendations for the use of induction chemotherapy, optimal radiation dose, value and timing of esophagectomy, use of chemotherapy vs. chemoradiotherapy before surgery, approach and extent of lymphadenectomy, and the value of adjuvant therapy after resection.

“These comprehensive guidelines address areas critical for standardizing and improving care and outcomes for esophageal cancer patients,” says study investigator Stephanie Worrell, MD, clinical associate professor and thoracic section chief at the University of Arizona in Tucson. “The recommendations are based on a comprehensive review of innovations and advancements in the most recent literature.”