General Thoracic

Reassessing Efficacy: Understanding Failures in Lung Cancer Screening Despite Low-Dose CT Protocol Adherence, a study presented at the 2025 STS Annual Meeting by Case Western Reserve University medical student Victoria Shiqi Wu, analyzes clinical and demographic factors contributing to lung cancer deaths among patients undergoing low-dose CT (LDCT) screening. Despite the substantial benefits of LDCT in detecting lung cancer early, some patients still succumb to the disease, raising important questions about the effectiveness of current screening approaches for certain populations.

The study utilized data from the National Lung Screening Trial, examining 16,081 patients with negative (normal) initial LDCT scans. Screening success was defined as either remaining cancer-free or surviving lung cancer. Screening failure was characterized by:

•    Receiving three negative scans but dying of lung cancer.
•    Being diagnosed with stage 4 lung cancer.
•    Having a positive scan but still succumbing to the disease.
 

Key Findings

Out of the total cohort, 98.1% (15,775 patients) experienced screening success. Among the 306 patients diagnosed with lung cancer, 33.3% had successful outcomes, while 66.6% faced screening failure.

The study identified several factors significantly associated with screening failure, including:

• Age over 70: Patients in this age group faced a 2.65 times higher risk (95% CI: 1.66-4.12).
• Male sex: Male patients were 1.56 times more likely to experience failure (95% CI: 1.13-2.17).
• Current smoking: Smokers had a 2.03 times higher likelihood of screening failure (95% CI: 1.52-2.73).
• Chronic obstructive pulmonary disease (COPD): Patients with COPD had 2.20 times the risk (95% CI: 1.35-3.46).
• Emphysema and sarcoidosis: Patients with these conditions faced elevated risks, with sarcoidosis showing an especially strong association (OR=7.99; 95% CI: 1.24-29.0).
• Firefighting work: Although less common, individuals in this occupation showed higher failure odds (OR=2.14; 95% CI: 0.99-4.07).
  Implications

The findings underscore the need for tailored interventions to improve LDCT screening outcomes for high-risk populations. Enhanced strategies may include:

•    Developing personalized screening protocols.
•    Implementing more aggressive smoking cessation programs.
•    Increasing surveillance for patients with comorbidities like COPD and emphysema.
 

The study highlights the importance of understanding the limitations of LDCT screening and targeting vulnerable groups to maximize its lifesaving potential. By addressing the identified risk factors, healthcare providers can take meaningful steps toward reducing lung cancer mortality.

At the 2025 Society of Thoracic Surgeons Annual Meeting, researchers will unveil a late-breaking study exploring the long-term survival outcomes of different surgical approaches for early-stage non-small cell lung cancer (NSCLC). The analysis leveraged the robust STS General Thoracic Surgery Database (GTSD), combined with long-term follow-up data, to evaluate the effectiveness of anatomic lung resections versus alternative techniques.

The study, to be presented by Dr. Christopher Seder, Rush University Medical Center, examined data from more than 32,000 patients, provides valuable real-world insights that complement existing randomized controlled trials, offering a comprehensive perspective on how surgical decisions influence outcomes over time. With findings drawn from diverse healthcare settings, this research underscores the potential of leveraging large-scale databases to refine treatment strategies and optimize patient care.

The STS GTSD remains a leading resource for capturing detailed surgical and patient data, driving advancements in cardiothoracic surgery. This latest study adds to its legacy by highlighting the importance of integrating real-world evidence into clinical practice.

In today’s presentation of the Clark Memorial Paper for General Thoracic Surgery, Lobectomy versus Sublobar Resection Among Lung Cancer Patients Understudied in Recent Clinical Trials, Gavitt Woodard, MD, a thoracic surgeon at Yale Medicine, will discuss the findings of a comprehensive evaluation of lung cancer surgery outcomes.

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This study examined survival outcomes across groups to determine whether the trial’s results are widely applicable to a broader population, including older patients, those with reduced pulmonary function, and non-smokers.

Researchers analyzed data from the Society of Thoracic Surgeons General Thoracic Surgery Database, linking it with Medicare survival data to evaluate patient outcomes. The study included a diverse group of patients who underwent different surgical resections, including lobectomy, segmentectomy, and wedge resection.

“The study found that sublobar resection and lobectomy offer similar survival outcomes for many patients, including those over 75, with poor lung function, or who are lifelong nonsmokers,” said Dr. Woodard. "Inadequate lymph node evaluation during sublobar resection was associated with worse survival. These findings highlight the need for better nodal assessment, particularly for patients with compromised lungs or minimal lymph node spread."

On day three of the STS 2025 Annual Meeting, Dr. Jeremiah Hayanga, professor of thoracic surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, will present a session titled, Endobronchial Valve Therapy (EVT) versus Lung Volume Reduction Survey (LVRS) in the US. In this presentation, Dr. Hayanga and his research team will share new, risk-adjusted study results that provide fresh insights into treatments for severe emphysema.

Recent findings suggest that as surgical practices evolve, LVRS may offer better long-term results for patients with advanced emphysema compared to EBV therapy. Although EBV patients had shorter hospital stays, lower charges, and fewer pre-existing conditions, the study revealed they experienced more complications and a higher risk of death over time than those who underwent LVRS.

To be held Sunday, Jan. 25, at 8 a.m. during the larger “Modernized Solutions for Lung Failure, From Bench to Bedside” session, Dr. Hayanga will also discuss the limitations of lung transplantation as a solution for severe emphysema due to the shortage of donor organs. 

“Surgical lung volume reduction, explored in the late 1990s, did not gain widespread acceptance due to its associated risks and the small pool of patients who were thought to benefit,” says Dr. Hayanga. “However, with advancements in surgical techniques and risk management, LVRS has seen improved outcomes, offering hope for patients who are not candidates for lung transplants.”

The rapid advancement of robotic technology has revolutionized the field of thoracic surgery. At the same time, the technological leap has highlighted a pressing need to bridge the educational gap in the training of thoracic surgery trainees. To address this issue, the Society of Thoracic Surgeons has developed an expert consensus document outlining a framework for a standardized national robotic curriculum.

A recent paper published in The Annals of Thoracic Surgery, authored by the Task Force on Robotic Thoracic Surgery and the Workforce on E-learning and Educational Innovation, has provided expert consensus statements for thoracic surgery training programs. This paper was created following an extensive literature review and expert consensus achieved through a modified Delphi process. It outlines expectations for programs, essential training components, as well as assessment and feedback methods.

Program Expectations

• Standardization: The consensus document advocates for standardized robotic thoracic curricula across all Accreditation Council for Graduate Medical Education-accredited programs.
• Dual Console Training: Trainees should have ample opportunity to practice on dual consoles during most cases to actively participate in the surgical process.
• Bedside Assistance: The presence of a trained bedside assistant during teaching cases is strongly recommended.

Components of Training

• Theoretical & Practical: The curriculum must integrate theoretical and practical learning.
• Pre-Console Training: Online modules on robotic components and hands-on training are mandatory before console surgery.
• VR Simulation: Proficiency in digital/virtual reality simulation modules is a prerequisite for console surgery.
• Wet Lab Training: Mandatory participation in at least one wet lab per year.
• Emergency Conversion: Mandatory to perform with the trainees or OR team at least once a year.

Assessment and Feedback

• Skill Assessment: Utilize objective tools like Global Evaluative Assessment of Robotic Skills to assess technical competency.
• EPA Development: Develop Entrusted Professional Activity for pulmonary resection.
• Performance Review: Regular video review and analysis of robotic performances provide valuable feedback.

By implementing the recommendations outlined in this expert consensus document, thoracic surgery training programs can ensure that trainees are well-prepared to perform complex robotic procedures and contribute to the advancement of thoracic surgery.

"Robotic surgery is rapidly evolving, and it's crucial that our training programs keep pace,” said Samuel Kim, MD, Northwestern Medicine, who chaired the task force that produced the document. "To ensure a skilled workforce capable of meeting the demands of modern thoracic surgery, we must prioritize a standardized curriculum that enhances resident education and bridges any existing educational disparities across training programs. By fostering a comprehensive learning environment that emphasizes both refined technical skills and sound clinical judgment, we can effectively train the next generation of surgical leaders."

Read the Annals article here.