the 9th conference of Asociacion Latinoamericana de Torax and Dr. Beltran

Highlights from the first day of the ALAT conference in Medellin, Colombia: the size matters debate and personalizing chemotherapy for advanced cancers

Medellin, Colombia


It’s a multidisciplinary conference that attracts a range of specialists (critical care medicine, pulmonology, oncology, surgery, rehabilitation medicine) that includes doctors, nurses, respiratory and physical therapists from across Latin America.

Much of the conference is divided by discipline in lecture series:  pulmonary medicine, critical care, sleep medicine ect..  Much of it is geared to pulmonary medicine but the are topics that appeal to everyone.

The first day is dedicated to discussions and debates on the latest research and development in chronic obstructive pulmonary disease (COPD), treatment of multidrug resistant Tuberculosis (MDR-TB and XDR-TB strains), tobacco cessation, ARDS and pulmonary rehabilitation.

Bypassing most of this for the thoracic surgery lectures series, Dr. Gustavo Lyons is moderating several discussions on thoracic surgery topics.  Dr, Lyon’s is the Director of the Thoracic Oncology division of ALAT, and Assistant Medical Director at the Hospital Britanico de Buenos Aires (British Hospital of Buenos Aires).

Dr. Gustavo Lyons of Buenos Aires, Argentina
Dr. Gustavo Lyons of Buenos Aires, Argentina

Dr. Rafael Beltran of the National Institute of Cancer gave the first lecture which was a discussion and presentation of research findings regarding the use of wedge resections (segmentectomies) versus lobectomies for cancer resection.

Dr. Rafael Beltran with Dr. Carlos Carvajal
Dr. Rafael Beltran with Dr. Carlos Carvajal

Dr. Beltran discusses some of the discrepancies in cancer detection and treatment world-wide.  Early diagnosis is a critical part of this  In Colombia, only 1/20 patients is eligible for surgical treatment at the time of detection where as that number falls to 1/5 in the United States.  (UK is 1/10 respectively).

The remainder of patients cancers are diagnosed at advanced stages when surgery is no longer a viable option.

During his talk, Dr. Beltran reviewed the literature surrounding lobectomy versus wedge resection (limited resection) for definitive cancer treatment.  While the majority of the thoracic surgery community agree that a lobectomy or anatomical resection is necessary for larger lesions, Dr. Beltran reviewed the literature relating to small lesions (less than 2 cm) when surgeons are able to get substantial margins with segmentectomies.

However, as Dr. Beltran reminded the audience, smaller wedge resections did not have a lower morbidity and mortality in comparison with lobectomies.

These mixed results suggest that segmentectomies be reserved for patients who would otherwise be ineligible for surgical resection due to advanced age/ frailty (75+ years), poor functional status and poor respiratory function.


Dr. Claudio Martin, an oncologist from Buenos Aires, Argentina also spoke as part of the block section – about the personalizing cancer treatment therapies, particularly in advanced stage lung cancers.  Personalization in this stance refers to the need to draw biomarkers and perform genetic testing.  This allows doctors to use targeted therapies – which is very effective in treating oncogene driven cancers.

Biomarker testing allows oncologists to determine what mutations (if any) are present (such as the Kras mutation).  This also helps the treatment team determine which chemotherapy agents will be the most effective (and least toxic) to patients.

A review of published literature shows that this approach – incorporating personalized therapies for cancer treatment based on the presence or absence of specific biomarkers or mutations shows a survival benefit of approximately 20 additional months when compared to patients receiving the standard regimen.



Author: K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

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