Why Do US and Canadian Surgeons View Cancer Treatment Differently?

Linda W. Martin, MD, MPH

Linda W. Martin, MD, MPH

Surgeons around the world differ in their perspectives about when, where, and how to treat advanced stage cancer of the lungs, esophagus, trachea, and mediastinum. Whether one plays it safe or pushes the envelope can depend upon the surgeon’s professional preference, but also may be influenced by what is standard practice geographically.

A session on Sunday morning—developed in collaboration with the Canadian Association of Thoracic Surgeons—will examine how cardiothoracic surgeons from both sides of the US and Canadian border approach the treatment of advanced stage cancer. 

“This will be an opportunity to talk about challenging cases where the answers are not clear and may be ‘out of bounds’ of any guidelines,” said Linda W. Martin, MD, MPH, from the University of Virginia Health System in Charlottesville. 

One differentiating factor between Canada and the US is regionalization. In the late 20th century, most Canadian provinces adopted a new approach to health care that consolidated complex care.  

“Canadian surgeons are willing to refer patients to centers of expertise. They don’t feel this is a negative for them. And Canadian patients are willing to travel a significant distance to get expert care at a high-volume center,” said Gail E. Darling, MD, from Toronto General Hospital and University Health Network, who will moderate the session with Dr. Martin. 

STS/CATS: Surgery for Advanced Stage Cancer—When Is Out of Bounds Not Out of Bounds?

10:00 a.m. – 12:00 p.m.
Room 215

In contrast, the US health care system is less regionalized. This appeals to American patients who generally prefer treatment close to home with shorter wait times. Most thoracic oncology surgeons see a wide variety of cases, from routine to complex. 

In both countries, evolving market pressures will continue to influence surgical paradigms. For example, the availability of systemic therapy can affect patient eligibility for surgery. 

“We are seeing occasional responses to systemic therapy that border on miraculous, with stage IV patients having durable responses with only residual cancer in the lung,” Dr. Martin said. “Part of our discussion will be centered on when—or if—we should consider operating in these situations.”

During Sunday’s 2-hour session, the presenters will go beyond the published literature to explain how surgeons in two different health care systems are thinking about these emerging scenarios: 

  • When to consider surgery for oligometastatic lung cancer
  • Which T4 lesions are appropriate for resection
  • The strengths and limitations of resection, ablation, or radiation for pulmonary metastases
  • How and when to implement salvage esophagectomy

Following each mini-lecture, the moderators will take a deep dive into the topic through a related case study and tumor-board style debate. Attendees also will have the opportunity to voice their opinions.

No matter which side of the border surgeons practice, and no matter which end of the surgical spectrum they represent, this session will offer new perspectives for advanced cancer care. “As surgeons, we should always be aware of what is possible,” said Dr. Darling.