A new, precision surgical approach to diagnosing and treating early-stage lung cancer

For patients with early-stage lung cancer, the journey from diagnosis to treatment can span several weeks or even months. During this time, patients may undergo multiple procedures. Research suggests that these delays can affect outcomes, with longer intervals between diagnosis and treatment associated with higher rates of recurrence and lower survival.   To address this, UCLA Health adopted a streamlined approach, combining diagnosis, staging, localization and treatment into a single operating room session and one anesthetic event. For select patients, the traditionally long diagnostic process can be completed in a few hours.

In this Interview, Bryan Burt, MD, professor and chief of thoracic surgery at UCLA and investigator at the UCLA Health Jonsson Comprehensive Cancer Center, and Reza Ronaghi, MD, an interventional pulmonologist and critical care physician at UCLA Health, discuss how the approach works.

Why is it so important to diagnose and treat early-stage lung cancer as quickly as possible?

Dr. Burt: Recent studies (show) that delays between the identification or diagnosis of early-stage lung cancer and surgery can worsen outcomes. In a recent UCLA study, the median time from identification of a suspicious nodule to surgery was 57 days. The study found that when this interval exceeded eight weeks, patients had lower overall survival and higher rates of recurrence. Our goal is to eliminate unnecessary delays and bring those steps together whenever it is appropriate.

Dr. Ronaghi: From the time a nodule or spot is detected in the lung to the time it is treated, patients… may need to see one physician for a biopsy, another for staging and then another for treatment, with each step potentially taking several weeks. This approach brings those steps together into one episode of care.

UCLA recently performed its first procedure combining diagnosis, staging, tumor localization and surgical treatment in a single operating room session. What exactly does this approach involve?

Dr. Ronaghi: A patient who has been… determined to be an appropriate candidate comes into the operating room and undergoes the (necessary procedures) during the same anesthetic event. Using robotic surgery, we can perform the biopsy, determine whether the cancer has spread, place a marker to help locate the tumor and, when appropriate, proceed directly to surgical removal.

Dr. Burt: There are four main steps. First, using robotic bronchoscopy, the suspicious lung nodule is biopsied and evaluated in real time. Second, we use endobronchial ultrasound (EBUS) to biopsy lymph nodes in the chest to determine whether the cancer has spread. Third, we can place a small marker into or next to the nodule to help the surgeon precisely locate a tumor during the operation. Fourth, if the cancer is confirmed to be early stage, the surgeon can proceed with robotic resection to remove the tumor.

How could this approach affect patients’ experience?

Dr. Burt: There is a very real patient experience benefit. Waiting between a suspicious scan, a biopsy, staging and treatment can be extremely anxiety-provoking.

Dr. Ronaghi: There’s also something powerful about being able to come in without a diagnosis and, several hours later, wake up having been diagnosed and treated, when appropriate. It is a minimally invasive approach, and patients can potentially wake up with only a few small incisions.

Who is eligible for this approach, and what factors do you consider?

Dr. Burt: This is not an approach for everyone. Patients are carefully selected based on their imaging and other clinical information.

Dr. Ronaghi: Patients would first meet with the appropriate specialists, including thoracic surgery and interventional pulmonology, and undergo the necessary imaging and preoperative evaluation. Not every patient needs all four steps. Going into the procedure does not necessarily mean the patient will ultimately undergo surgery.

What makes this a “precision” surgical approach, and where do you see this type of care going next?

Dr. Burt: Lung cancer is increasingly an example of precision medicine. We use tumor sequencing and biomarkers to determine the biology of a patient’s cancer and identify treatments that are most likely to work for that individual patient.

What excites you most about what this approach could mean for the future of lung cancer care?

Dr. Burt: What is exciting is the tangible impact we can have on patients. Thoughtfully adopting new technologies and treatment approaches allows us to improve care in ways that patients can actually experience.

Dr. Ronaghi: Advances in robotic bronchoscopy and robotic surgery have allowed us to combine these procedures while keeping the approach minimally invasive.