Single anesthetic pathways for the diagnosis, staging, and treatment of lung cancer: a narrative review

Background and Objective: Lung cancer remains the leading cause of malignancy-related deaths in the world. Delays in care are associated with higher rates of upstaging, increased 30-day mortality, and decreased median survival. Single anesthetic event (SAE) pathways have been developed to integrate advanced diagnostic bronchoscopy, rapid on-site cytohistologic diagnosis, and immediate surgical resection in one anesthetic procedure. This paper aims to summarize the existing data regarding SAE for lung cancer, outline indications for such protocols, and provide workflow pearls to improve efficiency. Methods: Studies from January 2021 to January 2026 using PubMed, Google Scholar, and Elsevier’s ScienceDirect databases were included for this narrative review. Studies that did not utilize SAE protocols or that were not written in English were excluded. Examples of search terms include “single anesthetic lung”, “robot assisted lung”, and “single anesthetic event”. Key Content and Findings: SAE has been shown to decrease time from biopsy to intervention by an average of 36 days for acceptable surgical candidates with intermediate to high-risk lung nodules. SAE has been associated with decreased cost, similar hospital length of stay, and equivalent complication rates when compared to conventional treatment pathways. Disadvantages of SAE include its requirement for resource-heavy environments due to needing multidisciplinary specialists on standby and access to robotic technologies. In order to succeed, SAE requires an updated computed tomography (CT) chest scan as well as excellent coordination between advanced bronchoscopists, thoracic surgeons, pathologists, and anesthesiologists. Conclusions: SAE for the diagnosis and treatment of patients with clinical stage I–II lung cancer has been shown to be safe and cost-effective in multiple initial studies. This paper includes workflow pearls utilized at our institution to guide centers who are newly adopting SAE protocols. Future multi-institutional and/or randomized studies, ideally stratified by lesion size, morphology, location, and adherence to established guidelines for low probability lesions, are needed before declaring SAE as a new standard of care.