Integrating interventional pulmonology and thoracic surgery: a multidisciplinary approach to advanced pulmonary care

Over the past two decades, significant advances in minimally invasive diagnostics and therapeutics have catalyzed subspecialization in pulmonary and thoracic disciplines. Interventional pulmonology (IP) has expanded the bronchoscopic management of complex airway disease, emphysema, lung cancer, and pleural pathology, while thoracic surgery (TS) continues to provide definitive operative therapies. As the diagnostic and therapeutic boundaries between these fields overlap, a coordinated multidisciplinary team (MDT) structure is warranted to optimize patient selection, reduce delays to efficient care, and offer a reasonable escalation pathway from minimally invasive to surgical approaches. At Beth Israel Deaconess Medical Center, the Chest Disease Center integrates IP and TS within a unified divisional structure supported by joint clinics, shared referral pathways, and routine multidisciplinary conferences involving radiology, oncology, and other specialties as needed. In this descriptive review, we present an institutional blueprint for integrated care using four representative disease domains: expiratory central airway collapse (ECAC), emphysema requiring lung volume reduction (LVR) strategies, early-stage lung cancer and peripheral pulmonary nodules (PPNs), and pleural disease including complicated pleural infection (CPI) and persistent air leak (PAL). Amongst those clinical entities, early dual-specialty evaluation enables timely diagnosis, individualized treatment planning, and streamlined transitions between bronchoscopic and operative options. Additionally, this framework also facilitates clinical research integration, including prospective trials embedded within routine workflows. We propose that a unified IP-TS MDT model enhances coordination, preserves continuity, and improves the efficiency of complex pulmonary care delivery, offering a practical template for adoption by other institutions seeking to align procedural innovation with patient-centered outcomes.