Surgical consensus for screening, diagnosis, staging, multimodal management and surveillance of early-stage resectable non-small cell lung cancer (NSCLC) in Malaysia

Abstract

Background: Lung cancer is the most frequently diagnosed cancer globally. In Malaysia, it ranks as the second most common cancer among men and third among women. Presently, no local clinical practice guidelines exist for lung cancer care in Malaysia. Given the lack of consensus regarding the perioperative management of early-stage non-small cell lung cancer (NSCLC), this article seeks to harmonise surgical practices among thoracic physicians and surgeons in Malaysia by recommending best practices for screening, diagnosis and staging, as well as multimodal management and surveillance in early-stage disease (stages I to IIIB-N2).

Methods: A local expert committee comprising nine high-volume actively practicing cardiothoracic or general thoracic surgeons gathered between February to July 2024 to deliberate existing evidence and formulate recommendations. A modified Delphi method comprising systematic review of published evidence and expert opinion based on local experience was utilised. The document was subsequently independently reviewed by two senior oncologists and two senior respiratory physicians, before incorporating their feedback into the final version.

Results: This document comprises a surgical consensus of evidence-based guidelines to provide local recommendations on contemporary real-world best practices. The consensus statements were grouped into five domains of early-stage resectable NSCLC: (I) screening (3 statements); (II) diagnosis and staging (6 statements); (III) neoadjuvant/perioperative immunotherapy (3 statements); (IV) adjuvant therapy with tyrosine kinase inhibitors (TKIs) or immunotherapy (4 statements); and (V) operative metrics and post-operative surveillance (5 statements).

Conclusions: These consensus statement guidelines will elevate and standardise the perioperative management of early-stage NSCLC in Malaysia, serve as a valuable educational and training tool for relevant medical professionals, and promote an inclusive, comprehensive multidisciplinary approach to integrated holistic patient care, aimed at improving both clinical outcomes and patients' quality of life with the best available evidence.

Keywords: Malaysia; Non-small cell lung cancer (NSCLC); perioperative; surgical consensus.