Joseph Friedberg, MD

Friedberg explains how an emphasis on physical fitness prior to and after surgery can significantly better long-term outcomes.

Managing Perioperative, Postoperative Lung Cancer, with Joseph Friedberg, MD

Timing is everything when setting the course toward surgically treating 

 — early detection, swift response, and prioritizing long-term rehabilitation. Key to timely execution is clear communication with patients, and established systems of collaboration between all the clinical stakeholders.

In the second segment of an interview with 

2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference

 in Philadelphia, PA, this week, Joseph Friedberg, MD, Thoracic Surgeon-in-Chief at Temple University and professor of thoracic medicine and surgery at Lewis Katz School of Medicine, talked about the optimal approach to surgically treating lung cancer — a strategy that is largely dictated by the stage of disease at the time of intervention.

“If the tumor is very small and peripheral, you may be able to do a very limited operation,” Frieberg said. “If it's significantly bigger than that — if you have, say, a five-centimeter tumor — even if you could do a smaller operation for it, that'd be the wrong thing to do. I mean, you're going in for a penny, in for a pound.”

What’s key in the pre-operative stage is setting a priority for rehabilitation for the sake of long-term benefit, Frieberg said. While lung tissue removal has a permanent effect on patients, there is opportunity in the first 1-2 years post-procedure to train the remaining lung tissue to manage as much capacity and function as it can from patients’ previous standards.

“And, you know, the upper lobes of the lung, for the most part, you can often take out that and have people — unless they're marathon runners — get back pretty close to where they started off,” Frieberg said. “Lower lobe is a different story.”

There’s little else to denote as a major development in the scope of lung cancer surgery, Friedberg said. Innovations present more as data supporting pre-operation efforts to improve patients’ physical fitness through pulmonary rehabilitation and achieve smoking cessation. These incremental wins can improve the likelihood of post-operative success — just as much as timely and frequent rehabilitation after surgery can benefit patients as well.

“You've got twice as much lung function as you need to do activities of daily living, unless you're doing heavy labor or something,” Friedberg said. “And these patients are getting pretty close to using up that reserve. So, the more they can get themselves conditioned like an athlete in training, the safer and easier everything's going to be.”

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Friedberg discusses the inconsistent clinical pathways from disease progression to intervention in patients with a pair of highly deadly lung diseases.

Characterizing COPD - Lung Cancer Patients, with Joseph Friedberg, MD

 remains the deadliest cancer in the US, despite the widespread availability of low dose computed tomography (CT) scanning and recently updated guidelines to expand the threshold for high lung cancer risk among current or former smokers.

 In fact, only just more than 1 in 8 high-risk patients were screened for lung cancer in 2024.

Interestingly, a highly common comorbidity in patients with lung cancer which increases the likelihood of mortality may also provide more opportunities for timely screening and escalation to life-altering care or surgery — just by presenting more apparently.

 at the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, PA, this week, Joseph Friedberg, MD, Thoracic Surgeon-in-Chief at Temple University and professor of thoracic medicine and surgery at Lewis Katz School of Medicine, discussed the burden and prevalence of 

By Friedberg’s estimation, approximately two-thirds of patients he performs lung cancer surgery on have a comorbid COPD diagnosis — an unsurprising rate, given the prevalence of either disease due to high risk factors including cigarette smoking. All the same, the presentation of comorbid COPD and lung cancer on low dose CT scans is very diverse.

“We’re seeing patients with suspicious lesions that would be radiographically occult on a chest X-ray — you wouldn’t even see them,” Friedberg explained. “We’re seeing a lot more ground glass opacities, which are hard-to-see smoking-related cancers. We’re seeing smaller lung cancers.”

These presentations are hardly relevant when addressing lung cancer, a predominately asymptomatic cancer until it has metastasized. Friedberg noted that the most common clinical presentation of lung cancer for years was seizures — an indication that it had already spread to a patient’s brain. The comorbid presentation of COPD may provide an incidental opportunity to identify potentially deadly lung cancer sooner than anticipated.

“Typically, we end up with patients who are discovered on an incidental finding — some trauma that warrants getting a CAT scan or an X-ray, that sort of thing,” Friedberg said. “These days, I would say that patient is [coming from] the emergency room or a family care physician who is just getting an annual screening and is referred to a pulmonologist.”

Jani CT, Singh H, Abdallah N, et al. Trends in Lung Cancer Incidence and Mortality (1990-2019) in the United States: A Comprehensive Analysis of Gender and State-Level Disparities. 

. 2023;9:e2300255. doi:10.1200/GO.23.00255

Kunzmann K. What Ails Lung Cancer Screening, with Douglas Wood, MD. 

. Published October 20, 2025.
https://www.hcplive.com/view/what-ails-lung-cancer-screening-douglas-wood-md

Joseph Friedberg, MD

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