Virginia R. Litle, MD, Consulting Editor

What’s controversial in our field? Aren’t we all on the same page when it comes to patient care? No, we’re not; thus, Drs Lana Schumacher and David Griffin have offered up 12 areas where management may differ between thoracic surgeons or between surgeons and their medical specialty colleagues. The evidence doesn’t always support one consensus, and (apparently) there can be more than one way to skin a cat, so they say. With relevance to us, however, in the operating room and clinic is that there may be several ways to approach esophageal, lung, airway, and mediastinal disease, but robust evidence lends guidance for best clinical practice.

In this issue of Thoracic Surgery Clinics, invited experts provide current data to help you navigate sometimes muddy waters. Drs Lazzaro and Inra share with us the value of working up patients with chronic cough, chronic obstructive pulmonary disease, and suspected tracheobronchomalacia. Collaborating with interventional and general pulmonologists to identify patients who may benefit from a workup and subsequent intervention, specifically robotic tracheobronchoplasty, can improve quality of life for these patients.

Oncologic management can be particularly challenging in the era of relatively speedy advances in systemic therapy for both lung and esophageal cancer and at a time when patients carry around an encyclopedia of knowledge in their back pocket. Dr Donington is one of our thoracic experts in the area of targeted and immunotherapy for lung cancer, so we welcome her thoughts with coauthor Dr Bryan, as they summarize how to approach stage IIIA non–small cell lung cancer. Unfortunately, the activity in this space contributes to even more controversies as they summarize: “…resectability, use of pneumonectomy, value of adjuvant versus neoadjuvant therapy and need to reassess the mediastinum prior to resection.” No shortage of research topics there! With regards to the early high-risk lung cancer patients, Dr Fernando has been addressing tumor ablation for years, and so he shares his thoughts with coauthors Drs Maxwell and Ng. Essentially, we look forward to the results of stereotactic radiation therapy versus resection randomized trials, and we should appreciate, and be involved in, the continued progress in bronchoscopic ablative therapies. Remember that advanced bronchoscopic training for surgeons is out there, although working with interventional pulmonology may be an efficient practice option as well.

Dr Antonoff has committed much research and mentoring time to investigating the area of pulmonary metastasectomy. Drs Eisenberg, Deboever and Dr Antonoff remind us that even in the era of immunotherapy, there is a role for metastasectomy, and for the time being the principle of controlling the primary and resecting all the metastases still should be used.

In the arena of benign esophagus, there’s never a shortage of discussion topics, including peroral endoscopic myotomy versus surgical myotomy for achalasia and how to manage gastroesophageal reflux disease (GERD). The value of a regularly scheduled benign esophagus conference, including the interventional, neurogastroenterologists, and community gastroenterologists, cannot be undervalued for thoracic surgeons with benign foregut practices. Dr Raja and colleagues at Cleveland Clinic share their expert insight on achalasia management, reflecting the busy practice there established by Dr Tom Rice and colleagues. And in this Thoracic Surgery Clinics issue, Dr Kim summarizes endoscopic approaches for GERD, an ever-evolving area in which techniques seem to pass distally as long-term results are reported.

Understanding the controversies and having data both aid in the shared decision-making conversations with patients, the discussion at multidisciplinary tumor boards as well as in resident education. Thank you to the excellent work and time of all the contributing authors and to the guest editors Drs Schumacher and Griffin. We hope this issue clears the water and helps you optimize patient care and satisfaction. Enjoy!

Sincerely,

Article infoIdentification

DOI: https://doi.org/10.1016/j.thorsurg.2023.02.001

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© 2023 Published by Elsevier Inc.

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