Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective

Area of Science:

• Thoracic oncology
• Surgical oncology
• Pulmonology

Background:

• Surgery is integral to multimodality treatment for early-stage nonsmall cell lung cancer (NSCLC).
• Thoracic surgeons play a critical role in lung cancer tumor boards, influencing patient selection for neoadjuvant/adjuvant therapies.
• The concept of resectability is fundamental for trial eligibility and treatment planning.

Approach:

• This review synthesizes key topics relevant to thoracic oncological surgeons and nonsurgical tumor board members.
• It addresses pre-operative assessment of surgical candidates, considering non-surgical treatment alternatives.
• The definition and implications of resectability are discussed in the context of clinical trials and treatment selection.

Key Points:

• Pre-operative fitness evaluation is crucial, especially with advancing non-surgical options.
• Clear definition of resectability guides patient inclusion in trials and radical treatment choices.
• Minimally invasive surgery, sublobar resections, and sleeve resections are emphasized to spare lung parenchyma and avoid pneumonectomy.

Conclusions:

• Optimizing surgical candidate selection and defining resectability are paramount for effective NSCLC management.
• The evolving role of minimally invasive and lung-sparing surgical techniques improves outcomes for early-stage NSCLC patients.
• Enhanced understanding of surgical principles by all tumor board members facilitates better multidisciplinary decision-making.