Skip to main content
Journal cover image

Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document.

Publication ,  Journal Article
Pennathur, A; Brunelli, A; Criner, GJ; Keshavarz, H; Mazzone, P; Walsh, G; Luketich, J; Liptay, M; Wafford, QE; Murthy, S; Marshall, MB ...
Published in: J Thorac Cardiovasc Surg
December 2021

OBJECTIVE: Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. METHODS: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. RESULTS: The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. CONCLUSIONS: Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

December 2021

Volume

162

Issue

6

Start / End Page

1605 / 1618.e6

Location

United States

Related Subject Headings

  • Risk Assessment
  • Respiratory System
  • Pneumonectomy
  • Patient Selection
  • Neoplasm Staging
  • Lung Neoplasms
  • Humans
  • Carcinoma, Non-Small-Cell Lung
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pennathur, A., Brunelli, A., Criner, G. J., Keshavarz, H., Mazzone, P., Walsh, G., … AATS Clinical Practice Standards Committee: Thoracic Surgery, . (2021). Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg, 162(6), 1605-1618.e6. https://doi.org/10.1016/j.jtcvs.2021.07.030
Pennathur, Arjun, Alessandro Brunelli, Gerard J. Criner, Homa Keshavarz, Peter Mazzone, Garrett Walsh, James Luketich, et al. “Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document.J Thorac Cardiovasc Surg 162, no. 6 (December 2021): 1605-1618.e6. https://doi.org/10.1016/j.jtcvs.2021.07.030.
Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, et al. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg. 2021 Dec;162(6):1605-1618.e6.
Pennathur, Arjun, et al. “Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document.J Thorac Cardiovasc Surg, vol. 162, no. 6, Dec. 2021, pp. 1605-1618.e6. Pubmed, doi:10.1016/j.jtcvs.2021.07.030.
Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, Luketich J, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Lanuti M, Wolf A, Pettiford B, Loo BW, Merritt RE, Rocco G, Schuchert M, Varghese TK, Swanson SJ, AATS Clinical Practice Standards Committee: Thoracic Surgery. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg. 2021 Dec;162(6):1605-1618.e6.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

December 2021

Volume

162

Issue

6

Start / End Page

1605 / 1618.e6

Location

United States

Related Subject Headings

  • Risk Assessment
  • Respiratory System
  • Pneumonectomy
  • Patient Selection
  • Neoplasm Staging
  • Lung Neoplasms
  • Humans
  • Carcinoma, Non-Small-Cell Lung
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology