Stage III Non-small Cell Lung Cancer Resectability in a Country With Limited Diagnostic and Therapeutic Resources: A...

IntroductionThe role of surgery in stage III non-small cell lung cancer (NSCLC), particularly in the presence of ipsilateral mediastinal lymph node involvement (N2), remains controversial. Criteria for resectability differ among existing clinical guidelines and are particularly difficult to apply in countries with limited access to advanced diagnostic and therapeutic resources. Accordingly, this Colombian expert consensus aimed to define resectability criteria for stage III NSCLC within real-world resource-limited contexts.MethodsThis expert consensus statement was developed by a multidisciplinary panel of Colombian experts following the European Society for Medical Oncology (ESMO) Standardized Operating Procedures. A structured literature review was conducted to inform structured clinical questions addressing resectability across different stage III NSCLC scenarios. Recommendations were formulated through iterative discussion and anonymous voting, with levels of evidence and grades of recommendation assigned according to ESMO methodology.ResultsConsensus was achieved for resectability in selected scenarios of single-station, non-bulky N2 disease, particularly in T1-2 tumors and T3 satellite lesions. Multi-station or bulky N2 disease was more frequently classified as potentially resectable in T1-2 tumors, with greater variability in expert agreement. For T4 disease, resectability depended on the pattern of invasion, nodal burden, and the feasibility of complete resection within a multimodality treatment strategy. Invasive restaging after induction therapy was strongly supported in selected scenarios. Across all recommendations, the panel emphasized the importance of multidisciplinary evaluation and individualized decision-making.ConclusionsThis consensus provides practical, context-specific recommendations on the resectability of stage III NSCLC in settings with limited diagnostic and therapeutic resources. By integrating available evidence with expert judgment, these recommendations aim to support multidisciplinary teams in selecting appropriate candidates for surgical management as part of multimodality therapy.