About

Andrea Axtell, MD, MPH, is an Assistant Professor in the Department of Surgery and Division of Cardiothoracic Surgery at the University of Wisconsin School of Medicine and Public Health. She serves as the Surgical Director of the UW Carbone Cancer Center's Thoracic Oncology Disease Oriented Team and is a member of the Lung Cancer Screening Program at the William S. Middleton Veterans Hospital. Her primary clinical practice includes the treatment of patients with thoracic malignancies, such as chest wall tumors, lung and esophageal cancer, and tracheal and mediastinal malignancies. She has a particular interest in developing minimally invasive techniques for cancer surgery and has expertise in thoracoscopic and robotic surgery, providing a wide range of services including bronchoscopy, thoracoscopic lobectomy, segmentectomy, extrapleural pneumonectomy, thoracoscopic thymectomy, chest wall tumor resection, thoracic reconstruction, tracheal resection, thoracoscopic talc pleurodesis, pleurectomy, decortication, minimally-invasive esophagectomy, and laparoscopic and robotic paraesophageal hernia repair. Her research interests focus on health services and clinical outcomes research, with a particular emphasis on the biology, screening, and management of lung cancer patients. She has expertise in predictive analytics, risk-development modeling, and outcomes research aimed at improving patient care.

Research topics

• Internal medicine
• Medicine
• Cardiology
• Surgery
• Oncology
• Pathology
• Cancer research

Selected publications

• STAS More than a Prognostic Marker—An Evolving Factor in Operative and Adjuvant Treatment Decisions in Early-Stage NSCLC

  Cancers · 2026-04-29

  articleOpen accessSenior author

  Since tumor spread through air spaces (STAS) was first described over a decade ago, numerous studies have demonstrated that it is a high-risk prognostic feature in non-small cell lung cancer (NSCLC). However, due to preoperative and intraoperative limitations in pathologic diagnosis, STAS is generally diagnosed following curative intent resection. While STAS should influence NSCLC treatment strategy-particularly upfront surgical decision-making-postoperative diagnosis of STAS has heretofore limited this possibility. While limited to retrospective studies, the current evidence suggests that patients with tumor STAS should undergo a more extensive anatomical resection-preferably a lobectomy, if they are candidates. These results are particularly important in the setting of the results of the JCOG0802 and CALGB 140503 randomized controlled trials which have begun a paradigm-shift toward sublobar resections for early-stage NSCLC, which may not hold similar benefit for early-stage STAS+ disease. The aims of this review are to: (1) detail the current evidence concerning choice of resection extent for STAS+ disease, (2) summarize the current evidence about optimum surgical margins for STAS+ disease, (3) detail the potential role for adjuvant chemotherapy in early-stage STAS+ disease, (4) assess the current limitations in preoperative STAS risk prediction and intraoperative STAS detection, and (5) highlight promising AI-based advancements which will allow surgeons to risk-stratify STAS probability or confirm STAS status intraoperatively. The main limitation of this review is the reliance on retrospective studies as there is a current lack of prospective or randomized data within STAS+ NSCLC, particularly regarding optimal resection strategy for STAS+ disease.

  PublisherDOI

• Non–Small Cell Lung Cancer, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology

  Journal of the National Comprehensive Cancer Network · 2026-04-01

  article

  The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Non-Small Cell Lung Cancer (NSCLC) provide recommendations for the treatment of patients with NSCLC, including diagnosis, primary disease management, surveillance, and subsequent treatment. The panel has updated the list of recommended targeted therapies based on recent FDA approvals and clinical data. This selection from the NCCN Guidelines for NSCLC focuses on treatment recommendations for advanced or metastatic NSCLC with actionable biomarkers.

  PublisherDOI

• Anastomotic Leaks After Esophagectomy—Severity and Impact on Quality of Life

  The Annals of Thoracic Surgery · 2025-05-02

  letter1st authorCorresponding
  PublisherDOI

• NCCN Guidelines® Insights: Non–Small Cell Lung Cancer, Version 7.2025

  Journal of the National Comprehensive Cancer Network · 2025-09-01 · 39 citations

  article

  The NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC) provide recommendations for the treatment of NSCLC. These NCCN Guidelines Insights discuss recent updates to the NCCN Guidelines, with a focus on systemic therapy options for the treatment of patients with nonmetastatic NSCLC and the corresponding molecular testing considerations.

  PublisherDOI

• The Presence of Both Tumor Spread through Air Spaces and Visceral Pleural Invasion May Increase Tumor Recurrence Risk in Non-Small Cell Lung Cancer

  Annals of Thoracic and Cardiovascular Surgery · 2025-01-01

  articleOpen accessSenior author

  PURPOSE: Tumor spread through air spaces (STAS) and visceral pleural invasion (VPI) are negative prognostic factors in lung cancer. However, it is unknown whether they have a compounding prognostic effect. Therefore, we analyzed the association between STAS and VPI with overall survival and recurrence. METHODS: A retrospective cohort analysis was conducted on 421 adult patients who underwent pulmonary resection for non-small cell lung cancer at an academic institution between 2018 and 2022. Baseline characteristics were compared between patients who had STAS only, VPI only, or both STAS and VPI. Overall survival and cumulative recurrence were compared using the Kaplan-Meier method. RESULTS: Of the 421 patients who underwent a pulmonary resection, 34 (8%) had both STAS and VPI. Their combined presence was associated with increased smoking pack-years, increased tumor size, and an increased presence of lymphovascular invasion. There was no overall survival difference (p = 0.190) between patients with both STAS and VPI and those with only one feature or neither. However, cumulative incidence of recurrence was increased (p = 0.001) for patients with both. CONCLUSION: The presence of STAS and VPI was not associated with decreased overall survival; however, their combined presence may have a compounding effect on recurrence risk.

  PublisherOA PDFDOI

• Sublobar Resection in Stage I Lung Cancer With Tumor Spread Through Air Spaces

  Annals of Thoracic Surgery Short Reports · 2025-02-13 · 2 citations

  articleOpen access1st authorCorresponding

  <h2>Abstract</h2><h3>Background</h3> Stage I lung cancer is increasingly being treated with sublobar resection. However, it is unknown whether patients with airspace invasion derive similar benefits. We therefore analyzed the association between tumor spread through air spaces (STAS) and survival. <h3>Methods</h3> A retrospective cohort analysis was conducted on 421 patients who underwent a lung cancer resection between 2018 and 2022 at an academic institution. Baseline characteristics were compared between patients who did and did not have STAS. Overall survival and disease recurrence were analyzed using Kaplan-Meier and Cox models. <h3>Results</h3> Of 421 patients who underwent lung cancer resection, 97 (23%) had STAS. There was no difference in STAS based on comorbidities or pulmonary function, however, patients with STAS were more likely to have higher pack-year smoking histories (47 vs 40 years, <i>P</i> = .041). Patients with STAS were more likely to have adenocarcinoma (91% vs 78%, <i>P</i> = .049), larger tumor size (2.6 vs 2.2 cm, <i>P</i> = .016), and lymphovascular invasion (46% vs 32%, <i>P</i> = .012). In patients with stage I disease, those with STAS who underwent sublobar resection had decreased overall survival compared with those without STAS (<i>P</i> = .042) or those who underwent lobectomy, regardless of the presence or absence of STAS. Five-year overall survival was 73% for stage I patients with STAS who underwent sublobar resection compared with 87% in patients without STAS, and 90% in patients without STAS who underwent lobectomy. <h3>Conclusions</h3> In patients with stage I disease, STAS is associated with decreased overall survival in patients who undergo sublobar resection; however, STAS does not affect overall survival after lobectomy.

  PublisherOA PDFDOI

• Sublobar Resection in Stage I Non-Small Cell Lung Cancer With Lymphovascular Invasion

  Annals of Thoracic Surgery Short Reports · 2025-11-01 · 1 citations

  articleOpen accessSenior author

  BACKGROUND Stage I lung cancer 2 cm is routinely being managed with sublobar (wedge or segmentectomy) resection.However, whether patients with lymphovascular invasion (LVI), an indicator of aggressive disease, gain similar benefits, is debated.METHODS A retrospective cohort analysis was conducted of 245 adult patients who underwent a resection for stage I non-small cell lung cancer (NSCLC) 2 cm at an academic institution from 2016 to 2022.Baseline characteristics were compared between patients with and without LVI.Overall survival and cumulative recurrence were compared using the Kaplan-Meier method.RESULTS LVI was present in 44 of 245 patients (18%) who underwent a resection for stage I lung cancer 2 cm.There was no difference in LVI based on comorbidities or pulmonary function.Patients with LVI were more likely to have poorly differentiated grade (59% vs 21%, P < .0005)and larger tumor size (1.6 cm vs 1.3 cm, P .0002).Patients with LVI-positive stage I disease 2 cm had significantly reduced overall survival (P .020);however, there was no difference in overall survival within LVI-positive patients when stratified by sublobar vs lobar resection extent (P .517).In stage I disease 2 cm, LVI-positive patients had increased cumulative recurrence compared with those without LVI (P .007);however, there was no difference in cumulative recurrence within LVIpositive patients when stratified by sublobar vs lobar resection type (P .756).CONCLUSIONS For stage I NSCLC 2 cm with LVI-positive disease, there is no statistically significant difference in overall survival or cumulative recurrence between sublobar and lobar resections.Thus, a completion lobectomy likely offers no meaningful clinical benefit in this patient population.

  PublisherOA PDFDOI

• Anastomotic Leak After Esophagectomy: Analysis of the STS General Thoracic Surgery Database

  The Annals of Thoracic Surgery · 2025-01-24 · 8 citations

  article1st authorCorresponding
  PublisherDOI

• Acute and Chronic Pulmonary Embolism

  Contemporary surgical clerkships · 2024-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

• Management of Tracheoesophageal Fistula and Tracheoinnominate Fistula

  Thoracic surgery clinics/Thorac. surg. clin. · 2024-08-13 · 3 citations

  reviewSenior author
  PublisherDOI

Frequent coauthors

• Mauricio A. Villavicencio

  Mayo Clinic

  46 shared

• David A. D’Alessandro

  Massachusetts General Hospital

  37 shared

• Serguei Melnitchouk

  30 shared

• George Tolis

  27 shared

• Thoralf M. Sundt

  Massachusetts General Hospital

  24 shared

• Sameer Hirji

  VA Boston Healthcare System

  23 shared

• Asishana A. Osho

  Massachusetts General Hospital

  21 shared

• Amy G. Fiedler

  20 shared

Education

• M.D.

  University of Wisconsin School of Medicine and Public Health

• Other

  University of Wisconsin School of Medicine and Public Health