Single Anesthetic Approach to Diagnosis, Staging and Treatment of Lung Cancer

Abstract

The conventional workup for suspected early-stage lung cancer requires multiple visits, anesthetics, and procedures. Single anesthetic event lung cancer surgery integrates shape-sensing robotic bronchoscopy, cone-beam CT, rapid on-site cytologic evaluation (ROSE), endobronchial ultrasound staging, lesion localization, and minimally invasive resection into one operative encounter. In this narrative review, we describe the technical components of this pathway, summarize the supporting literature, and offer expert, institution-based troubleshooting guidance for common intraoperative dilemmas. Reported diagnostic yields for shape-sensing robotic bronchoscopy range from 80 to 96%, with approximately 90% concordance between ROSE and final pathology. Published single-institution series report reductions in time from detection to resection of 15–51 days, cost savings of approximately $3000–$10,000, and perioperative outcomes (length of stay 1.8–3.6 days; complication rates comparable to traditional pathways) similar to staged care. The supporting evidence is retrospective and derived from small, single-institution, high-volume referral cohorts; no prospective comparative trials or long-term survival data yet exist. Single anesthetic event lung cancer surgery is therefore best regarded as an emerging, resource-intensive care pathway for carefully selected patients at experienced centers rather than an established standard of care, pending prospective, multicenter validation.