Some 1,600 professionals from all over the world will meet next Sunday in Barcelona for the 32nd congress of the European Society of Thoracic Surgeons (ESTS), one of the most relevant conclaves of the specialty that has lung cancer as its focus. main workhorse. However, despite the fabulous advances in surgery, the key to survival is not only in the operating room. “What most influences the prognosis is that we diagnose it earlier,” says Laureano Molins, director of the thoracic surgery service at the Hospital Clínic, organizer of the congress and former president of the ESTS.
The malignant tumor of the trachea, bronchi and lung is the second most common in Spain, behind breast cancer, and the most lethal, causing 22,438 deaths in 2021, a fifth of deaths due to cancer. 80% of cases are diagnosed in advanced stages (3 and 4), which until five years ago were not operable. So only 20% of the patients (diagnosed in the early stages) were susceptible to surgery, which clearly improves the prognosis.
In recent times, after treating patients with chemotherapy and immunotherapy, surgeons can intervene in between 15 and 20% of advanced tumors. In these cases, survival has gone from 10 months to 25 or 30 months in the last 15 years. Where surgery clearly improves the prognosis is in tumors in the initial stages, which is why Molins highlights the relevance of early diagnosis and screening programs.
Three weeks ago, the Clínic hospital involved volunteers participating in the Cassandra project, a program to evaluate the effects of early detection in which 42 hospitals from 16 autonomous communities participate. People at risk (smokers between 50 and 75 years old or people who have quit tobacco in the previous 15 years) undergo spirometry and a scan to detect the existence of nodules in the lungs.
In Molins’ opinion, the results will not vary from previous international studies that indicate tumor detection in the initial stage in 80% of cases. A chest CT scan at the Clínic costs 136 euros, a mammogram, 62. Should lung cancer screening be incorporated into the portfolio of services? The cost-benefit controversy appears: tumors operated on in stage 1 are cured in 80% of cases; Treatment of more advanced stages, which require chemo and immunotherapy, is almost twice as expensive, according to some studies.
“We have improved a lot in stages 3 and 4, but we have not completely cured them,” says the surgeon. The appearance of video thoracoscopy (minimally invasive surgery) around 1992 began the path of evolution. Around 2019, robotics began to be applied to pulmonary surgery and it is beginning to be demonstrated that it is equally valid, or superior, to videothoracoscopy.
The professionals at the ESTS congress will attend several papers on this topic. And after robotics? Artificial intelligence and big data arrive to refine the discrimination of benign and malignant tumors. According to Molins, currently in 10% of cases they go to the operating room without having a clear diagnosis of a malignant tumor. “We can refine more,” she explains, with AI analyzing and comparing parameters such as shape, size, density or spiculation with thousands of tumors.