Lobectomy for Suspected Lung Cancer Without Prior Diagnosis

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Diagnostic lobectomy for suspected lung cancer without prior pathologic confirmation is a recognized surgical practice.
• This approach is utilized when clinical suspicion for malignancy is high, but definitive tissue diagnosis is unavailable preoperatively.

Purpose of the Study:

• To describe the utilization, patient characteristics, and outcomes of diagnostic lobectomy for suspected lung cancer.
• To compare outcomes between lobectomies performed with and without preoperative pathologic confirmation of lung cancer.

Main Methods:

• A retrospective review of lobectomy or bilobectomy procedures for suspected or confirmed primary pulmonary malignancy was conducted.
• Data were sourced from The Society of Thoracic Surgeons database, comparing cases with and without preoperative biopsy confirmation.

Main Results:

• Of 2651 lobectomies, 48.4% were performed with clinical suspicion but without preoperative confirmation.
• In cases without preoperative diagnosis, 90% ultimately proved to be lung cancer, while 10% were nonmalignant (e.g., granulomas, pneumonia).
• Operative mortality was low (1.0% for diagnostic lobectomy), with patient age and lobectomy type influencing the decision for diagnostic lobectomy.

Conclusions:

• Lobectomy for suspected lung cancer without preoperative diagnosis is common and reflects practice variation.
• While diagnostic lobectomy infrequently involves nonmalignant disease, tissue confirmation prior to surgery is preferred, especially in high-risk patients.
• Diagnostic lobectomy can be considered acceptable for carefully selected patients and lesions.