During this webinar, presenters will look at surgeon readiness for operating following neoadjuvant immunotherapy and targeted therapies, while sharing new knowledge of pathology review and standardized assessment of pathologic complete response (pCR). The program reinforces the rationale for adjuvant therapy continuation, drawing on evidence from AEGEAN, including event-free survival outcomes, pathology-linked insights, and postoperative treatment sequencing. The session also defines the surgeon’s role in educating patients across the full treatment journey.
The Best Science Presented at the 2026 European Lung Cancer Congress
The STS 2026 Best of Lung Cancer Sciencespecial edition podcast series provides members with direct access to the most clinically relevant and practice-informing advances in lung cancer, curated and interpreted by thoracic surgeons for thoracic surgeons.
In recognition of National Women’s Health Month, this episode of Thinking Thoracic analyzes the evolving landscape of female-specific lung cancer care. Co-hosts Dr. Erin Gillaspie and Dr. Jane Yanagawa sit down with guest Dr. Leah Backhus to discuss a critical disparity: lung cancer is the leading cause of cancer death among women, yet screening practices remain inequitable.
Determining the optimal management strategy for pleural mesothelioma (PM) remains one of the most challenging areas in thoracic oncology. As a rare and aggressive malignancy, PM requires careful coordination of diagnostic, surgical, and systemic therapies. While surgery has historically played a central role, its benefit continues to be debated.
The Society of Thoracic Surgeons (STS) 2026 Expert Consensus on the Multimodal Treatment of Pleural Mesothelioma, developed by a multidisciplinary panel and published in The Annals of Thoracic Surgery, provides updated recommendations on the multimodal management of PM, with particular emphasis on the role of surgical intervention.
Bridging Evidence and Real-World Practice
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Dr. Jeffrey Velotta
A key challenge addressed in the document is the gap between clinical evidence and real-world outcomes. According to lead author Jeffrey Velotta, MD, of Kaiser Permanente Oakland Medical Center, that gap is often driven by differences in surgical experience. “The biggest divide is between general thoracic surgeons and those with high-volume mesothelioma experience,” Velotta said, noting that outcomes are closely tied to disease-specific expertise and case volume. He emphasized that many studies and guidelines do not fully account for this variability. “Mesothelioma-specific experience—not just general surgical skill—can significantly impact outcomes,” he added.
Refining Diagnosis and Staging
A central theme of the recommendations is the importance of accurate diagnosis and staging. The panel strongly emphasizes that adequate pleural biopsy is essential for confirming histologic subtype, which directly influences prognosis and treatment decisions.
In addition, the consensus highlights the critical role of advanced imaging:
CT and PET imaging: Required at a minimum to assess disease extent.
Multidisciplinary Tumor Board (MTB): Essential for treatment planning, involving surgeons, oncologists, radiologists, and pathologists with specific PM expertise.
Multimodal Therapy as the Standard Approach
The consensus emphasizes that PM treatment should integrate surgery with systemic therapies such as chemotherapy, immunotherapy, or radiation. When evaluating surgical candidates, the panel suggests focusing on several key clinical indicators:
Histologic subtype: Greatest benefit is seen in epithelioid, localized disease; outcomes remain poorer for sarcomatoid and biphasic subtypes.
Performance status: A patient's overall functional ability is an independent prognostic indicator.
Physiologic reserve: Careful assessment of cardiopulmonary function and nutritional levels.
Case volume: Surgery should be concentrated in high-volume centers with documented experience in PM management.
“Patients benefit most from a multimodal approach that combines surgery with systemic therapy,” Velotta said.
One of the most definitive recommendations is the strong preference for lung-sparing surgical techniques. Pleurectomy/decortication (P/D) and extended P/D (EPD) are favored over extrapleural pneumonectomy (EPP), which carries higher morbidity without a clear survival advantage in contemporary studies. “Lung-sparing surgery, when performed in experienced centers, can offer meaningful long-term benefits with acceptable risk,” Velotta noted.
Treatment Sequencing and Ongoing Uncertainty
Therapy sequencing remains an area of active debate, with both neoadjuvant and adjuvant approaches considered reasonable. Velotta highlighted two key unanswered questions: “We still don’t know whether chemotherapy is best given before or after surgery, and whether intraoperative adjuncts should be used routinely.”
Recent data, including the MARS-2 trial, have also questioned the overall benefit of surgery, though the panel emphasizes ongoing controversy related to trial design and differences in surgical expertise.
A Framework for Complex Decision-Making
As treatment strategies for pleural mesothelioma continue to evolve, the STS consensus provides a structured yet flexible framework for clinicians. While acknowledging gaps in high-quality evidence, the panel emphasizes the importance of expertise, multidisciplinary care, and individualized treatment planning which includes surgery in a multimodal regimen to optimize patient outcomes.
In this episode of Thinking Thoracic, podcast hosts Hari Keshava, MD, and Erin Gillaspie, MD, talk with René Petersen, MD, of Copenhagen University Hospital, about the latest developments in Enhanced Recovery After Surgery (ERAS) protocols.
As a longtime leader and pioneer in the field, Dr. Petersen shares insights from his extensive experience advancing recovery practices. The conversation covers the broader evolution of minimally invasive thoracic surgery, including video-assisted approaches, and how these developments inform patient selection for tubeless procedures.
In the season two premiere episode of Thinking Thoracic, cohosts Drs. Erin Gillaspie, Hari Keshava, Jeff Yang, and Jane Yanagawa review the latest thoracic surgery research presented at the 2026 STS Annual Meeting in New Orleans.
On Sunday, Feb. 1 at 10:45 a.m., during the “Advancing Lung Cancer Screening Implementation in Real World Settings” session, Dr. Elliot Servais of Lahey Hospital and Medical Center will present The Society of Thoracic Surgeons Expert Consensus on Surgical Quality Standards for Lung Cancer Screening Detected Nodules. As chair of the STS Task Force responsible for the consensus document, Dr. Servais will walk attendees through comprehensive, multidisciplinary recommendations designed to standardize perioperative care for CT lung cancer screening programs nationwide.
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Dr. Elliot Servais
Lung cancer screening with low-dose CT has proven effective in reducing disease-specific mortality, but wide variation in how programs manage screen-detected nodules persists. To address this, the STS convened a multidisciplinary panel to review the evidence and establish clear benchmarks for diagnostic evaluation, complication rates, and timeliness of intervention. Through a structured literature review and modified Delphi process, the panel produced 23 consensus statements focused on improving safety, consistency, and coordination in screening pathways.
Key recommendations include permitting surgery without a preoperative tissue diagnosis in select patients—preferably using minimally invasive, parenchymal-sparing techniques—and rejecting pneumonectomy without a diagnosis.
In his presentation, Dr. Servais will also highlight why certain targets, such as achieving a benign resection rate below 10%, may challenge some programs. “Meeting this benchmark requires consistent multidisciplinary review, judicious use of preoperative biopsy, and a willingness to follow equivocal lesions closely—approaches that can reduce unnecessary surgery and improve patient outcomes,” says Dr. Servais.
By integrating diverse clinical perspectives, programs can better determine when invasive intervention is warranted versus when surveillance is safest, improving decision-making and minimizing avoidable procedures.
“Thoracic surgeons must remain central to lung cancer screening programs, and adherence to strong perioperative quality standards—rooted in multidisciplinary evaluation, operative safety, and timely intervention—is critical to ensuring that lung cancer screening continues to save lives with minimal harm to patients,” adds Dr. Servais.
NEW ORLEANS—January 31, 2026—A nationwide, real-world analysis using the STS General Thoracic Surgery Database (GTSD) from 2012 to 2023, analyzed 16,056 adults who underwent esophagectomy for primary esophageal cancer to develop and validate a long-term all-cause mortality risk model.
NEW ORLEANS—January 31, 2026—Heart specialists at Mayo Clinic today presented new research at the 2026 Society of Thoracic Surgeons Annual Meeting that redo surgery for adults with congenital heart disease (CHD) remains high-risk, and a clinically applicable national risk assessment model is needed to help patients and care teams make decisions about procedures.
NEW ORLEANS—January 31, 2026—Breakthrough research presented at the 2026 Society of Thoracic Surgeons Annual Meeting shows that additional lymph node evaluation is needed during surgery for non-small cell lung cancer (NSCLC) to accurately identify cancer spread.
On Friday, Jan. 30, at 9:30 a.m., Stephanie Worrell, MD, of the University of Arizona, presented STS Perforation Guidelines during the "Esophageal Perforation Management" session. Her talk introduced a new Society of Thoracic Surgeons (STS) Expert Consensus Document designed to improve the diagnosis and management of esophageal perforation, a rare but potentially fatal condition.
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Dr. Stephanie Worrell
Esophageal perforation, often a complication of endoscopic procedures, requires early diagnosis, as mortality and morbidity increase if treatment is delayed beyond 24 hours. Despite advances in treatment, management remains inconsistent due to the condition’s rarity and limited clinical data.
To address this gap, the STS convened a multidisciplinary panel of thoracic surgeons and gastroenterologists, who reviewed studies from the past 14 years to develop consensus statements on diagnosis, treatment, and long-term care. For stable patients with confirmed perforation, the consensus supports endoscopic therapies when matched appropriately to anatomy and operator expertise. Surgical intervention remains essential for unstable patients or complex cases.
In her talk, Dr. Worrell discussed how the guidelines provide clarity in clinical scenarios that often prompt uncertainty. “These recommendations clarify when further investigation is appropriate and when it’s safe to observe or discharge,” she said. She notes that the guidelines are particularly valuable for conditions like spontaneous pneumomediastinum where further workup may be unnecessary. Additionally, there is now strong data for CT esophagrams and growing evidence for endoscopic approaches that are not yet used consistently.
