General Thoracic

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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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.

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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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.

As part of the “Research in Focus: Landmark Science & Technology” session on day one of the STS meeting, Andrew Feczko, MD, of Cleveland Clinic presented the STS Landmark paper titled Lung Cancer Resection Longitudinal Risk Model. In his presentation, Dr. Feczko described the development and validation of a robust, data-driven model designed to predict long-term survival following curative-intent lung cancer resection—an area of growing importance as survival improves and quality benchmarking extends beyond perioperative outcomes.

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Drawing on the Society of Thoracic Surgeons General Thoracic Surgery Database, the investigators analyzed outcomes from a large, contemporary cohort of adults who underwent lung cancer resection. By linking STS data with national mortality sources, the team was able to assess survival over an extended follow-up period and construct individualized risk predictions across pathologic stages. Patients were divided into derivation and validation cohorts to ensure the model’s generalizability, and advanced statistical techniques were used to account for differences in risk over time.

The resulting longitudinal risk model demonstrated strong discrimination and excellent calibration, accurately aligning predicted survival with observed outcomes across multiple time points and disease stages. Risk scores were closely associated with long-term survival, effectively stratifying patients into distinct prognostic groups. Importantly, the model’s performance improved further when postoperative complications were incorporated, highlighting the lasting impact of perioperative events on long-term outcomes.

Dr. Feczko emphasized that this work addressed a critical gap in thoracic surgery by extending risk assessment beyond short-term mortality. As the field increasingly focuses on survivorship, quality improvement, and informed shared decision-making, the availability of validated long-term survival models represents a significant advance.

With this study, the STS General Thoracic Surgery Database now offers thoracic surgeons both short- and long-term risk prediction tools to support self-evaluation, programmatic quality improvement, and future research—reinforcing its role as the authoritative national resource for thoracic surgical outcomes.

On Thursday, January 29, the Society of Thoracic Surgeons (STS), in collaboration with the International Society for Heart and Lung Transplantation (ISHLT), hosted the inaugural STS/ISHLT Lung Transplantation Symposium as part of the STS 62nd Annual Meeting. This full-day specialty session provided a practical, multidisciplinary review of contemporary lung transplantation, covering donor selection through long-term management with an emphasis on intraoperative decision-making and complex clinical scenarios.

“Through its practical, comprehensive approach, the symposium offered attendees an in-depth perspective on modern lung transplantation,” said organizing chair Kewal Krishan, MD. “The program equipped surgeons and care teams with strategies for both routine and highly complex cases.”

The program combined didactic lectures, live debates, and case-based panels to highlight advances in donor management, organ preservation, surgical techniques, and perioperative care. Attendees earned CME credits while engaging in detailed discussions of common challenges in lung transplantation surgery.

Sessions delivered a case-based overview across the operative spectrum—from donor management and organ preservation to complex intraoperative rescue. Faculty reviewed retrieval strategies in donation after brain death and circulatory death, surgical implantation techniques, perioperative anesthesia and hemodynamic management, and the use of ECMO or cardiopulmonary bypass. Advanced scenarios, including robotic, redo, and heart–lung transplantation, concluded with interactive discussions focused on real-world, high-risk cases.

During the "Diagnosing Patients: Do You Know Before You Go?" session on day one of STS 2026 at 10:15 a.m., Talal Alzghari, MD, of One Brooklyn Health-Brookdale University Hospital Medical Center, will present Oncological and Surgical Outcome Differences in Never-Smoker Women Compared to Ever-Smoker Women and Men. In this presentation, Dr. Alzghari examines how gender and smoking status independently shape surgical and long-term outcomes following lung cancer resection—an increasingly important question as lung cancer rates continue to rise among women.

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Although smoking remains the leading risk factor for lung cancer, prior studies have shown conflicting results regarding its impact on postoperative outcomes when gender is considered. To clarify these relationships, Dr. Alzghari and colleagues analyzed national registry data to compare perioperative and oncologic outcomes among women and men with differing smoking histories who underwent resection for non-small cell lung cancer (NSCLC).

Analyzing more than 145,000 elective NSCLC resections from the Society of Thoracic Surgeons General Thoracic Surgery Database, the investigators found that never-smokers are becoming more common over time in both men and women. Never-smoker women emerged as a distinct group with fewer comorbidities, lower perioperative risk, and the most favorable long-term survival, while ever-smoker men experienced the highest complication rates and poorest survival. These differences persisted after risk adjustment, highlighting the independent influence of both gender and smoking status on surgical and oncologic outcomes..

In his presentation, Dr. Alzghari will discuss how these findings can inform preoperative counseling, risk stratification, and treatment planning for patients undergoing lung cancer surgery. He emphasizes that understanding the combined effects of gender and smoking history is essential to delivering more personalized, data-driven care for patients with NSCLC.

Breakthrough research to be presented at the 2026 Society of Thoracic Surgeons (STS) Annual Meeting suggests that more comprehensive lymph node assessment during surgery is critical to accurately staging and treating patients with clinically node-negative non-small cell lung cancer (NSCLC). Christopher Seder, MD, thoracic surgeon and professor of surgical sciences at Rush University Medical Center, will present the J. Maxwell Chamberlain Memorial Paper in General Thoracic Surgery, Association Between Nodal Assessment, Upstaging, and Survival in Resected Clinically Node-negative Non-small Cell Lung Cancer, on Saturday, Jan. 31, at 7:35 a.m. during the “Research in Focus: Distinguished Abstracts” session.

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Although imaging may indicate that NSCLC has not spread to lymph nodes, global surgical standards vary widely regarding how many nodes should be removed and evaluated. In North America, guidelines introduced in 2021 recommend assessment of one N1 node in the hilar or root of the lung and three N2 nodes in the mediastinum. Using data from the STS General Thoracic Surgery Database, researchers found that this approach may miss disease spread, as cancer was more frequently identified in N1 nodes than in N2 nodes, with many metastatic nodes located adjacent to the bronchi. The study recommends removal and evaluation of more than one N1 node in addition to at least three N2 nodes.

The analysis examined a large, multi-center cohort of clinically node-negative NSCLC patients treated over a three-year period. Patients underwent wedge resection, segmentectomy, or lobectomy, and a meaningful proportion were upstaged after surgery when lymph node dissection revealed more advanced disease than initially diagnosed. Patients who received neoadjuvant therapy, underwent preoperative mediastinoscopy, lacked PET-CT imaging, or had incomplete pathology data were excluded. Expanded nodal assessment improved detection of occult disease, enabling more accurate staging and more appropriate use of chemotherapy and additional treatments.  

“We are narrowing down the best techniques for lymph node dissections in patients with lung cancer to give the best chance of identifying any cancer that is there and improving survival,” says Dr. Seder. “The onus here is not only on surgeons to dissect out more lymph nodes, but on pathologists to take this lung specimen we give them and do a very thorough evaluation of that lung specimen to get all the additional lymph nodes with cancer that are hiding in the specimen.”
 

Lung cancer causes more deaths in the United States each year than breast, colon, and prostate cancers combined. Yet, despite strong evidence showing that annual screening with low-dose CT (LDCT) scans significantly reduces lung cancer mortality among high-risk individuals^[1],^[2], fewer than 18.2% of eligible patients currently undergo screening.

Simultaneously published in The Annals of Thoracic Surgery, The Journal of the American College of Radiology, and The International Journal of Radiation Oncology, Biology, Physics and jointly issued by The Society of Thoracic Surgeons (STS), The American College of Radiology (ACR), and The American Society for Radiation Oncology (ASTRO), the article examines recurring methodological flaws in the literature that may limit knowledge of, and access to, lung cancer screening (LCS).

The editorial originated from the STS Lung Cancer Screening Task Force and was led by its chair, Elliot Servais, MD, Department of Surgery at Lahey Hospital & Medical Center.

“In this paper, we address these misconceptions head-on with the goal of expanding access to screening and saving more lives from lung cancer,” said Dr. Servais. “Lung cancer screening saves lives. Multiple high-quality studies have clearly demonstrated its benefit. Despite this strong evidence, persistent misinformation about perceived harms continues to limit the uptake of this life-saving test.”

The authors note that methodological shortcomings in published research—including overestimation of downstream complications, misrepresentation of false-positive rates, and flawed analyses of CT-related radiation risk—may deter patients and clinicians from lung cancer screening, highlighting the need for accurate, evidence-based communication of its benefits and risks.

The full joint editorial is now available online:

[1] DOI: 10.1056/NEJMoa1911793 
[2] DOI: 10.1056/NEJMoa1102873