Considerations about the complete resection in NSCLC surgery. Review

The complete resection for NSCLC is analyzed through the study of a series of retrospective surgical reports upon the incomplete resection, due to a microscopic residual tumor at the resection margin. Following Shields' statement in 1974, the incomplete resection represents, in fact, the basic study protocol for the local recurrence following the resection of primary NSCLC. First of all, the obligation for a careful intraoperative pathologic assessment upon the resection margins, clearly emerges from this study. Secondly, two main aspects featuring the incomplete resection have also been pointed out. The first is represented by the historical microscopic residual tumor at the bronchial resection margin, while the second, more recently recognized, is represented by the critical resection margin within the involved ipsilateral mediastinal lymphatic area. The analysis of such different figures leads to different considerations when dealing with the basic matter of the local-regional completeness of resection and the oncological result in terms of cure. In fact, while the problem of the bronchial remnant appears amenable to further improvement by activating the surgical attention, the second, instead, is to be considered unmodifiable by the surgery alone. It basically depends on the extended microvascularity of the large lymphatic mediastinal network which appears to be the crucial factor of risk for such a "lymphatic" resection margin. In conclusion, the matter of complete resection is still open to further research provided that the design is strictly prospective. As a matter of fact, so far the expectation for cure in any apparently completely resected NSCLC is ruled by other well-known factors of prognosis which do not consider the quality of the resected margin at all.