Considerations about the complete resection in NSCLC surgery. Review.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pathology

Background:

• Retrospective analysis of incomplete resections in non-small cell lung cancer (NSCLC) highlights the significance of microscopic residual tumor at resection margins.
• Historically, incomplete resection has served as a model for studying local recurrence following primary NSCLC resection.

Discussion:

• Intraoperative pathological assessment of resection margins is crucial for determining the completeness of NSCLC resection.
• Two key aspects of incomplete resection are identified: microscopic residual tumor at the bronchial margin and critical resection margins in the ipsilateral mediastinal lymphatic area.
• The bronchial margin issue is potentially addressable through enhanced surgical attention, whereas the mediastinal lymphatic margin is largely unmodifiable by surgery alone due to extensive microvascularity.

Key Insights:

• Mediastinal lymphatic involvement represents a critical, surgery-unmodifiable risk factor for local-regional recurrence in NSCLC.
• The extensive microvascularity of the mediastinal lymphatic network contributes to the challenge of achieving complete resection in these cases.
• Current prognostic factors for NSCLC cure do not adequately account for the quality of the resection margin.

Outlook:

• Future research on complete NSCLC resection requires strictly prospective study designs.
• Further investigation is needed to develop strategies for improving outcomes in cases with mediastinal lymphatic involvement.
• Integrating margin quality assessment into prognostic models may enhance predictions for NSCLC cure.