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 |