Managing Perioperative, Postoperative Lung Cancer, with Joseph Friedberg, MD

Timing is everything when setting the course toward surgically treating lung cancer — early detection, swift response, and prioritizing long-term rehabilitation. Key to timely execution is clear communication with patients, and established systems of collaboration between all the clinical stakeholders.

In the second segment of an interview with HCPLive during the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, PA, this week, Joseph Friedberg, MD, Thoracic Surgeon-in-Chief at Temple University and professor of thoracic medicine and surgery at Lewis Katz School of Medicine, talked about the optimal approach to surgically treating lung cancer — a strategy that is largely dictated by the stage of disease at the time of intervention.

“If the tumor is very small and peripheral, you may be able to do a very limited operation,” Frieberg said. “If it's significantly bigger than that — if you have, say, a five-centimeter tumor — even if you could do a smaller operation for it, that'd be the wrong thing to do. I mean, you're going in for a penny, in for a pound.”

What’s key in the pre-operative stage is setting a priority for rehabilitation for the sake of long-term benefit, Frieberg said. While lung tissue removal has a permanent effect on patients, there is opportunity in the first 1-2 years post-procedure to train the remaining lung tissue to manage as much capacity and function as it can from patients’ previous standards.

“And, you know, the upper lobes of the lung, for the most part, you can often take out that and have people — unless they're marathon runners — get back pretty close to where they started off,” Frieberg said. “Lower lobe is a different story.”

There’s little else to denote as a major development in the scope of lung cancer surgery, Friedberg said. Innovations present more as data supporting pre-operation efforts to improve patients’ physical fitness through pulmonary rehabilitation and achieve smoking cessation. These incremental wins can improve the likelihood of post-operative success — just as much as timely and frequent rehabilitation after surgery can benefit patients as well.

“You've got twice as much lung function as you need to do activities of daily living, unless you're doing heavy labor or something,” Friedberg said. “And these patients are getting pretty close to using up that reserve. So, the more they can get themselves conditioned like an athlete in training, the safer and easier everything's going to be.”