Evolution of Lung Cancer Surgery: Historical Milestones, Current Strategy, and Future Innovations

Lung cancer surgery has advanced significantly over the decades, profoundly impacting patient outcomes and surgical practices. This review examines the major historical milestones in lung cancer surgery-from early pneumonectomies to the establishment of lobectomy as the standard treatment for resectable non-small cell lung cancer (NSCLC) and the subsequent evolution toward sublobar resections (including segmentectomy and wedge resection) for early-stage NSCLC. Growing evidence for the efficacy of sublobar resections has redefined the surgical approach for early-stage lung cancer by shifting the focus from lobectomy to less invasive procedures. However, despite the demonstrated non-inferiority of sublobar resections, concerns about locoregional recurrence continue to pose a major challenge. Addressing this issue is essential for optimizing surgical outcomes in early-stage NSCLC. One promising innovation to mitigate recurrence is the novel asymmetrical linear stapler (NALS), which represents a significant advancement in stapling technology for minimally invasive lung cancer surgery. This review traces the evolution of lung cancer surgery from the 1960s to 2024, focusing on key milestones and the role of NALS in addressing current challenges.