April 14, 2026
Lung cancer remains the leading cause of cancer-related deaths in the U.S., primarily due to late-stage diagnosis. Mayo Clinic is at the forefront of changing that narrative through early detection and innovative surgical techniques aimed at preserving as much lung function as possible.
Thoracic surgeons in Rochester, Minnesota, are pushing the boundaries of lung cancer care by refining diagnostic methods, personalizing surgical approaches and identifying patients who may benefit from therapies beyond surgery. Working in tandem with the multidisciplinary lung cancer team, they are helping people live longer, healthier lives.
Robot-assisted bronchoscopy for lung cancer diagnosis, staging and treatment
Robot-assisted bronchoscopy is a widely used tool for lung nodule biopsies. Janani S. Reisenauer, M.D., a thoracic surgeon, interventional pulmonologist and chair of Thoracic Surgery at Mayo Clinic in Rochester, Minnesota, was one of the first thoracic surgeons in the U.S. to use robotic bronchoscopy and establish its accuracy and safety.
In the past, it was common to let small nodules get bigger before sampling them. "We no longer have to wait," Dr. Reisenauer says. "By pairing robotic-assisted bronchoscopy with advanced imaging, we can reach the vast majority of lung nodules, including those that are small and peripheral."
"With new immunotherapies, surgery is now an option for more people with advanced-stage disease, leading to better outcomes."
An important benefit of robot-assisted bronchoscopy is the ability to combine it with other procedures. Lymph nodes can be sampled for staging at the same time as a lung nodule biopsy. For some patients, lung cancer can be diagnosed and surgically removed under the same anesthetic. Combining biopsy and surgery requires the evaluation of surgical specimens in real time, an uncommon service that Mayo Clinic offers routinely.
Comprehensive approaches to lung cancer surgery
The trend in lung cancer surgery is moving toward less invasive techniques that effectively treat cancer while leaving patients with as much lung function as possible. One way to do that is to perform sublobar resection instead of lobectomy.
Results from a large phase 3 trial that included Mayo Clinic were recently published in the New England Journal of Medicine. The study found similar disease-free survival in patients with stage 1 non-small cell lung cancer who underwent sublobar resection compared with lobectomy.
Thoracic surgeons at Mayo Clinic perform approximately 95% of lung cancer procedures using minimally invasive video-assisted thoracic surgery and robot-assisted thoracic surgery. "Lungs are a precious commodity," says Stephen D. Cassivi, M.D., M.S., a thoracic surgeon at Mayo Clinic. "When we plan surgery, we have to be very thoughtful to spare tissue."
As a high-volume center, Mayo Clinic offers minimally invasive and open lung cancer surgery for all types of lung cancer. Some of the most complex cases include patients with:
- Emphysema. Patients with lung cancer and emphysema who meet certain requirements may be eligible for minimally invasive, tissue-sparing surgery. This approach is based on previous studies on lung volume reduction surgery in patients with emphysema.
- Recurrent lung cancer. Some lung cancers that recur after a previous surgery are operable, including those in patients who have had one lung removed.
- Small cell lung cancer. Small cell lung cancer is often diagnosed at an advanced stage and considered untreatable with surgery. Mayo Clinic's team-based approach allows for more-precise evaluation of each patient's case. Through their combined expertise, thoracic surgeons and medical oncologists can identify select patients who may be candidates for surgery, offering hope where few options once existed.
Expanding the curability of lung cancer today and tomorrow
Breakthroughs in medical therapies are changing what surgeons consider operable and potentially curable. Mayo Clinic participated in multiple early neoadjuvant immunotherapy trials that showed positive response rates and operability in patients with advanced-stage lung cancer. "With new immunotherapies, surgery is now an option for more people with advanced-stage disease, leading to better outcomes," Dr. Reisenauer says.
Other breakthroughs are on the horizon, offering patients who come to Mayo Clinic the earliest access to potentially life-changing care. Current efforts are exploring ways to:
- Deliver ablative therapies to lung cancer using robot-assisted bronchoscopy.
- Develop new screening guidelines to account for the rise in lung cancer in people who never smoked.
- Establish blood, saliva and sputum tests to detect lung cancer.
- Harness artificial intelligence to determine which nodules on CT scans are suspicious and require biopsies or removal.
- Identify novel biomarkers that may unlock opportunities for new-generation therapies.
- Refine surgery to address lung changes caused by neoadjuvant immunotherapy.
- Understand how tumors interact with their three-dimensional environment.
- Use carbon ion radiation therapy to treat lung cancer.
These trends highlight the importance of the multidisciplinary lung cancer team, which includes interventional pulmonologists, surgeons, radiation oncologists, medical oncologists and others. "Our collective experience creates a broader footprint to help each patient," Dr. Cassivi says. "We're getting better at identifying the specifics of cancer and determining the right treatment path for each individual patient."
For more information
Altorki N, et al. Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer. New England Journal of Medicine. 2023;388:489.
Refer a patient to Mayo Clinic.