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Important developments in lung cancer surgery

Professor of Cardiothoracic Surgery, in particular pulmonary surgery, Jerry Braun will give his inaugural lecture on Friday 23 September entitled ‘Out of countless millions’. Braun has been a professor and acting head of the LUMC’s Department of Cardiothoracic Surgery since January 2020. Covid meant his inaugural lecture had to be postponed to now. As a result Braun can include the latest developments in lung cancer surgery.

Small tumours detected sooner

In his inaugural lecture Braun will discuss three important developments in surgery. First, is the increase in small tumours that are discovered by chance at an early stage. This is because CT scans of the thorax are performed more frequently in connection with other conditions. At this early stage it is often no longer necessary to remove an entire lung lobe. A segmental resection will suffice instead. This means a more tailored solution for the patient. New technology is being developed for this and the LUMC is leading the way.

The second development Braun will discuss in his inaugural lecture is how surgery is increasingly becoming part of multimodal therapy. ‘Patients are treated in advance with chemotherapy, radiotherapy or immunotherapy or a combination of therapies before an operation is performed. There is increasing evidence that surgery is worthwhile in selected patients with advanced lung cancer. As you reduce the size of the tumour in the pre-treatment, it often suffices for us surgeons to “only” remove a lobe instead of a whole lung. This is obviously better for the patient.’

Better understanding of biological behaviour of tumours

The third development Braun will cover is how “salvage surgery” will become more common. This is surgery in patients with metastatic cancer who are treated with immunotherapy and respond very well to this. ‘We sometimes see spectacular results. The metastases disappear on the scans and sometimes only one spot remains on the lung. Or there is one spot on the lung that starts to grow again. Some of these people can still be operated on to achieve longer disease-free survival. This field is fairly new. The future will tell what the surgeon’s contribution actually means for the patient’s prognosis.’

Braun believes the new developments are linked to a better understanding of the biological behaviour of tumours, the development of new therapies such as immunotherapy and targeted therapies, and advanced surgical technology. ‘It’s an exciting and fast-changing field.’

In favour of concentrated care

After explaining these new developments in surgery, Braun will move on to the topic of concentrated care.  ‘At the moment 41 centres perform oncological lung surgery. There are 2,400 lung cancer operations in the Netherlands every year.  If all the centres did the same number, that would mean 58 operations per centre per year. That amounts to just over one per week. That’s not a huge quantity,’ says Braun. 

There is a lot of discussion about these numbers, says Braun, but he at any rate is in favour of greater concentration of oncological lung surgery. His motto is: the more you do as a team, the better you become at it. He is optimistic, therefore, about the recent Integral Healthcare Agreement. One aspect of this is to aim for a minimum of 50 to 100 operations per hospital. The minimum now is 20 per year. 

Don’t wait for the minister

Braun’s message is clear: ‘You can keep on discussing this number, of course, but if we disregard this number and look instead at how together we can ensure we treat patients even better, then concentration is the only answer. So let’s not wait for the minister to decide but come up with our own plans instead. Then we at least remain in control and can influence what this care will be like. We have to do that together with pulmonologists and patient associations.’

Jerry Braun’s inaugural lecture can be followed live from 16.15 on Friday 23 September on the Leiden University website.


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