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Table 1 Summary for decision-making in different pathologies during phase 1

From: A tentative guide for thoracic surgeons during COVID-19 pandemic

Pathology What to operate What to defer
NSCLC • Solid or predominantly solid (> 50%) lung cancer or presumed lung cancer ≥ 2 cm, clinical node negative
• Post-induction therapy cancer
• Predominantly ground glass (< 50% solid) nodules or cancers
• Solid nodule or lung cancer < 2 cm
• Indolent histology (e.g., carcinoid, slowly enlarging nodule)
➢ Alternatives include:
• SABR, neoadjuvant therapy
• Ablation, stent, or debulking for endobronchial lesions
Esophageal tumors • Esophageal cancer T1b or greater
• Stenting for obstructing esophageal tumor
Esophageal cancer T1a/b (superficial) could be managed endoscopically.
Chest wall Chest wall tumors of high malignant potential not manageable by alternative therapy Chest wall tumors of high malignant potential manageable by alternative therapy
Mediastinal tumors Symptomatic mediastinal tumors—diagnosis not amenable to needle biopsy • Thymoma (non-bulky, asymptomatic)
• Posterior mediastinal neurogenic tumors
Other oncothoracic interventions Staging to start treatment (mediastinoscopy, diagnostic VATS for pleural dissemination) Pulmonary oligometastases—unless clinically necessary for pressing therapeutic or diagnostic indications (i.e., surgery will impact treatment)
Others • All emergency cases as massive hemothorax, major airway injury, airway obstruction by inhaled foreign body or advanced tracheal stenosis, and diaphragmatic hernia with strangulation
• Loculated empyema with sepsis that cannot otherwise be treated
• Tension emphysematous bullae with respiratory distress
• Recurrent pneumothorax with massive air leak
• Pectus surgery
• Hyperhidrosis
• Bronchiectasis
• Tracheal resection in tracheostomized patients
• Non-malignant pleural effusion
• Elective bullectomy
  1. SBRT stereotactic body radiation therapy, VATS video-assisted thoracoscopic surgery