Application of a Novel Hybrid Surgery Strategy in Elderly Patients with Multiple Primary Lung Cancers: A Prospective Validation Study

According to the latest cancer data of WHO, lung cancer (LC) remains the leading cause of incidence and mortality both globally and in China. The diagnosis and treatment of multiple primary lung cancer (MPLC) continue to pose significant challenges for clinicians. As the global population ages, an increasing number of elderly patients are being diagnosed with MPLC, drawing greater attention to the health and longevity of this demographic. Although video-assisted thoracoscopic surgery (VATS) is the preferred treatment method for MPLC, there is no clear consensus on the optimal treatment strategy. Elderly MPLC patients often have multiple comorbidities and reduced physiological function, making surgery more risky and postoperative recovery more difficult. Achieving tumor eradication while minimizing trauma and maximizing lung function preservation is a pressing clinical challenge. In recent years, ablation technology has matured, offering a promising local treatment option for MPLC. The combination of VATS and ablation therapy leverages the advantages of surgery in achieving radical resection, lymph node dissection, and precise pathological staging, while also taking advantage of the minimal trauma, repeatability, and limited lung function loss associated with ablation therapy.

Our research team, as a leading national center of thoracic surgery, performed this hybrid surgery in China and published the largest retrospective case study globally to date. Our preliminary studies have demonstrated that the hybrid surgery is highly safe and feasible in the general MPLC population and significantly improves postoperative quality of life. However, high-level evidence and standardized protocols for elderly MPLC patients remain lacking, and the broader applicability of this innovative strategy requires further investigation. Building on our previous research, our team plans to conduct a multicenter real-world study based on a prospective clinical cohort. This study will compare VATS combined with thermal ablation versus VATS alone in elderly MPLC patients, focusing on both unilateral and bilateral MPLC. We will evaluate and compare the two treatment modalities in terms of safety, efficacy, lung function loss, postoperative complications, postoperative quality of life, long-term survival, and health economics. The goal is to develop and disseminate best practices for the treatment of elderly MPLC patients, providing a basis for establishing the optimal individualized treatment strategies, improving the health service system for the elderly, and offering China’s experience and treatment solutions to address global aging.