Lung cancer surgery: an up to date

Area of Science:

• Oncology
• Thoracic Surgery
• Cancer Epidemiology

Background:

• Lung cancer is a major global health concern, with high incidence and mortality rates, particularly in Greece.
• The Tumor, Node, Metastases (TNM) staging system is critical for determining treatment strategies, differentiating between curative and palliative approaches.
• Surgical resection plays a significant role in lung cancer management, with lobectomy considered the gold standard, though alternatives exist for specific cases.

Purpose of the Study:

• To review the current understanding of lung cancer treatment, focusing on surgical interventions and their efficacy.
• To highlight the importance of disease extent and staging in guiding treatment decisions for lung cancer patients.
• To discuss the role of various surgical techniques, including VATS lobectomy, in managing different stages of lung cancer.

Main Methods:

• Review of epidemiological data from GLOBOCAN reports for global and Greek lung cancer statistics.
• Analysis of the TNM staging system's role in treatment stratification.
• Discussion of surgical techniques, including lobectomy, segmentectomy, and VATS lobectomy, and their indications.
• Consideration of N2 disease management and the implications for surgical versus non-surgical treatment.
• Evaluation of Small Cell Lung Cancer (SCLC) treatment paradigms.

Main Results:

• Lung cancer represents a significant portion of cancer incidence and mortality in Greece, especially among males.
• Lobectomy is the standard surgical treatment, but segmentectomy is an alternative for early-stage or functionally limited patients.
• Chest wall invasion does not preclude resection, with en-bloc rib resection being the preferred method.
• N2 disease management is complex, with chemoradiotherapy often primary, but surgery may be considered after downstaging.
• Video-assisted thoracoscopic surgery (VATS) lobectomy is a safe and widely adopted technique.
• Complete resection is crucial for favorable 5-year survival rates, which are stage-dependent.

Conclusions:

• Surgical resection, particularly lobectomy and VATS lobectomy, is a cornerstone in lung cancer treatment.
• Accurate staging and consideration of patient-specific factors are essential for optimizing surgical outcomes.
• While N2 disease presents challenges, advancements in multimodal therapy offer improved management options.
• Complete tumor resection is paramount for achieving long-term survival in lung cancer patients.