ARTICLE IN PRESSEuropean Joumal of Surgical Oncology xxx (xxxx)xxxContents lists available at ScienceDirectEuropean Journal of Surgical OncologyELSEVIERjournal homepage:www.ejso.comLung Cancer resection in the absence of pre-operative histology:TheAccuracy of Multidisciplinary Team ConsensusJack Whooley .Rebecca Weedle a,David Breen Alan Soo aCardiothoracic Surgery Department,Galway University Hospital Galway.IrelandbInterventional Respiratory Unit,Department of Respiratory Medicine,Galway University Hospitals,Galway.IrekandARTICLE INFOABSTRACTArticle history:Background:Lung resection remains the gold-standard of treatment for non-small cell lung cancerReceived 10 December 2022(NSCLC)British Thoracic Society (BTS)guidelines recommends the pursuit of pre-operative histologicalReceived in revised formdiagnosis and staging where possible.In the absence of pre-operative histology,surgical treatment can30 March 2023Accepted 12 April 2023be offered in conjunction with multidisciplinary team (MDT)and patient consensus.We undertook aAwvailable online xxxsingle-centre analysis of the accuracy of the lung cancer MDT in recommending surgical resection forthose with suspected lung malignancy in the absence of pre-operative histological diagnosis over a six-Keywordsyear period.Non-small cell lung cancerMethods:A retrospective review was performed of patients undergoing any pulmonary oncologicalMulti-disciplinary teamresection with therapeutic intent without pre-operative histological diagnosis at the recommendation ofThoracic surgerythe lung cancer MDT in our unit between May 2016 and July 2022.LobectomyResults:270 consecutive patients underwent lung resection for a lung nodule of indeterminate signifi-cance.This accounted for 45%of the oncological resections performed over this period.The mean age ofthe cohort was 67.9 years,and 47.4%were male.Overall,10%of resected specimens (n 27)were benignon final histopathology.93%of those undergoing a lobectomy received a malignant diagnosis.Across thestudy cohort,surgical resection was well tolerated with a low complication rate.Condusions:Lung cancer resection in the absence of pre-operative histological diagnosis is feasible in aselect patient cohort.This approach requires an experienced multi-disciplinary team and careful patientcounselling.Our study demonstrates this adapted approach to be a pragmatic solution to the manage-ment of indeterminate pulmonary nodules in centres where biopsy is not routinely available due toexisting constraints on the health system.2023 Elsevier Ltd,BASO -The Assodation for Cancer Surgery,and the European Society of SurgicalOncology.All rights reserved.1.Introductionmalignancy is high (either >70%[1]or >65%[6]using a combina-tion of the brock and herder malignancy risk scores),which con-There is widespread agreement amongst international guide-flicts with the European Society for Medical Oncology (ESMO)[4]lines that surgical resection forms the cornerstone of curativeand the United Sta
