Does occupational exposure affect the surgical management of patients with non-small cell lung cancer? A single-center retrospective experience

Objective

Non-small-cell lung cancer (NSCLC) remains a major public health concern, with tobacco and environmental exposures to carcinogens (such as asbestos, radon, and silica) recognized as major risk factors. This study investigates the impact of occupational exposure, particularly to crystalline silica on peri‑ and postoperative outcomes in patients undergoing surgery for NSCLC.

Methods

A retrospective analysis was performed on 251 patients who underwent lobectomy or segmentectomy between 2018 and 2021, with occupational exposure data collected postoperatively.

Results

Our findings suggest that patients with occupational exposure, particularly to silica, asbestos, or multiple carcinogens, have more complex surgical courses, including longer operative times, higher rates of conversion from minimally invasive to open surgery, and increased postoperative complications (Clavien-Dindo grade II or higher). Preoperative lymph node staging was less accurate in exposed patients, in part because of inflammatory changes such as fibro-hyaline lesions, which can cause false-positive PET/CT findings.

Conclusions

The study highlights the need for tailored surgical strategies and accurate lymph node staging in exposed individuals. Future research should focus on prospective studies to refine perioperative management and explore the biological mechanisms driving these complications.