Kuzdzal教授指出，ELCC 2016展示多个领域的研究进展，微创手术治疗是其中之一。Kuzdzal教授的报告介绍了一些提高手术效果和预后的策略。

　　改善肺癌患者的手术预后的主要措施有：①减小手术损伤，选择更加微创切除术（比如亚肺叶切除），切除更少的肺组织；②集中大量病例的数据库（reference center ），手术治疗结果和预后的确认依赖于数据量，一些医学院校的数据中心在术后并发症、总生存率、死亡率方面的研究成果斐然，最佳利用了医院资源，最大程度地降低了成本，在医疗保健单位面临着资金短缺的情况下，这一点非常重要；③ 改善术后加速康复（Enhanced Recovery After Surgery，ERAS）方案 ，目的是缩短住院时间，优化医院资源的利用，降低并发症发生率，加速康复。优化ERAS包括：术前准备、术中策略、术后护理；④多学科治疗：多学科的肿瘤治疗方法包括手术治疗、放疗、系统治疗，肿瘤治疗团队应包括病理学家、放疗专家、麻醉科医生等等。

　　在立体定向放疗(SBRT)vs手术治疗可手术切除早期肺癌方面，本届ELCC 会议有基于高质量科学数据的讨论。目前我们已经有了几个随机试验的结果，因为方法学上的缺点，研究结果并不非常可靠。到底选择SBRT治疗还是手术，也要取决于医生的专业能力。一般来说，外科医生倾向手术治疗，放疗专家倾向SBRT。从中立的角度来看，我们都或多或少地认为：对于可手术患者，手术治疗是首选，因患者手术后可进行组织学评估（SBRT则不能），手术不仅治疗肿瘤，也可对淋巴系统进行处理。SBRT只能治疗肿瘤本身。SBRT可能是肿瘤非常小（＜1 cm）、不适合手术或手术风险很高的患者的首选。肿瘤较大、身体条件较好的患者的首选是手术。SBRT和手术之间并不冲突，二者相辅相成的，都是我们能为患者提供的最佳治疗方法。当然，未来的随机试验会提供更多的可靠数据，帮我们做出更好的决策。

访谈原文：

　　Oncology Frontier:Minimally invasive treatment is hot topic of this conference，Is there any progress that may change practice in Lung Cancer?

　　《肿瘤瞭望》：ELCC 2016是否有展示肺癌微创治疗的重要研究进展？

　　Dr Kuzdzal: Yes of course. There are many fields where there is progress. Minimally invasive approaches to surgery is one of them， but certainly not the only one. In my presentation， I tried to outline some other strategies that aim to improve the results and outcomes of treatment.

　　Kuzdzal教授：本次会议展示多个领域的研究进展，微创手术治疗是其中之一。我的报告介绍了一些提高治疗效果和预后的其他策略。

　　Oncology Frontier:Would you please talk about the measures to improve outcomes after surgery?

　　《肿瘤瞭望》：如何改善肺癌患者的手术预后？

　　Dr Kuzdzal: Minimization of invasiveness of both the approach and the resection itself is one those measures. The second most important， in my opinion， is the concentration of cases in large referral centers. We now have overwhelming data confirming that results and outcomes depend strictly on volume. Big university centers do better in terms of post-operative complications， overall survival， mortality in the post-operative period and also in terms of the optimal use of hospital resources and costs. The latter is important nowadays when we are all facing a shortage of funding in healthcare. The third important emerging area is the ERAS protocols to enhance recovery after surgery which are also driven by the economy. Apart from being associated with cost-saving， they also correlate with better results so patients are also benefiting. The last one is the philosophy of multidisciplinary treatment. Today， I don’t think anyone has any doubts that that is the right way to go and that lung cancer can only be treated properly when it is managed within multidisciplinary protocols. None of us has all the knowledge and all the skills and we have to supplement each other. Together， we can decide on the right way to treat our patients.

　　Kuzdzal教授：改善肺癌患者的手术预后的主要措施有：①减小手术损伤，选择更加微创切除术（比如亚肺叶切除），切除更少的肺组织；②集中大量病例的数据库（reference center ），手术治疗结果和预后的确认依赖于数据量，一些医学院校的数据中心在术后并发症、总生存率、死亡率方面的研究成果斐然，最佳利用了医院资源，最大程度地降低了成本，在医疗保健单位面临着资金短缺的情况下，这一点非常重要；③ 改善术后加速康复（Enhanced Recovery After Surgery，ERAS）方案 ，目的是缩短住院时间，优化医院资源的利用，降低并发症发生率，加速康复。优化ERAS包括：术前准备、术中策略、术后护理；④多学科治疗：多学科的肿瘤治疗方法包括手术治疗、放疗、系统治疗，肿瘤治疗团队应包括病理学家、放疗专家、麻醉科医生等等。

　　Oncology Frontier:Is there any new sights on “Surgery versus SABR for resectable non-small-cell lung cancer”?

　　《肿瘤瞭望》：在立体定向放疗(SBRT)vs手术治疗可手术切除早期肺癌方面，ELCC 2016有无提出新观点？

　　Dr Kuzdzal: There are ongoing discussions and these discussions are based mainly on good quality scientific data. We have the results of a few randomized trials but these have a few methodological drawbacks so the results are not always very reliable. There is also the question of competence between specialties. Generally， surgeons have a preference for surgical treatment while radio-oncologists have a preference for stereotactic body radiotherapy (SBRT). If we try to look at this problem from a neutral perspective， I think we all more-or-less agree that for patients who are fit for surgery， that is the preferred treatment， because it provides a very good histological assessment which cannot be done after SBRT， and also because it allows treatment of the lymphatic system. SBRT treats only the tumor itself and omits the lymphatic system completely. SBRT may be preferred for the very small tumors (<1 cm) in patients who are not fit for surgery or for whom the operative risk is considered high. On the other hand， for larger tumors and for patients who are fitter， the preferred treatment would be surgery. I do not consider this decision as a conflicting decision. The two modalities supplement each other and having both of them at our disposal means we can deliver the optimal treatment for each patient. Of course， future randomized trials will probably elucidate things better and we will have more data to make decisions with， which will be evidence-based.

　　Kuzdzal教授：ELCC 2016对SBRT VS 手术展开了基于高质量科学数据的讨论。目前我们已经有了几个随机试验的结果，因为方法学上的缺点，研究结果并不非常可靠。到底选择SBRT治疗还是手术，也要取决于医生的专业能力。一般来说，外科医生倾向手术治疗，放疗专家倾向SBRT。从中立的角度来看，我们都或多或少地认为：对于可手术患者，手术治疗是首选，因患者手术后可进行组织学评估（SBRT则不能），手术不仅治疗肿瘤，也可对淋巴系统进行处理。SBRT只能治疗肿瘤本身。SBRT可能是肿瘤非常小（＜1 cm）、不适合手术或手术风险很高的患者的首选。肿瘤较大、身体条件较好的患者的首选是手术。SBRT和手术之间并不冲突，二者相辅相成的，都是我们能为患者提供的最佳治疗方法。当然，未来的随机试验会提供更多的可靠数据，帮我们做出更好的决策。

　　Oncology Frontier:ELCC 2016 released the results of a number of studies，  which study are you most interested in?

　　《肿瘤瞭望》：ELCC 2016发布了多项研究结果，您对哪项最感兴趣？

　　Dr Kuzdzal: There are many studies and I am probably not the right person to judge because this conference， although multidisciplinary， is focused mainly on medical oncology. As systemic treatment is not my area of expertise， I wouldn’t want to judge the new treatment modalities such as biological strategies. I think there are other specialists who are much more qualified to make judgments.

　　Kuzdzal教授：本次会议涉及多个学科，系统治疗不是我的专业领域，我不想判断新的治疗方式，比如生物治疗策略。我认为应该有其他更有发言权的专家。