Inconsistent definitions of radical resection in perioperative trials of non-small cell lung cancer: a scoping review

Perioperative therapies have altered curative-intent treatment for resectable non-small cell lung cancer (NSCLC). Nonetheless, radical resection (R0) still remains one of the most vital determinants of the final clinical outcome. This study evaluates the definition of radical resection across perioperative NSCLC trials in the context of the National Comprehensive Cancer Network (NCCN) and International Association for the Study of Lung Cancer (IASLC) guidelines.

A scoping review in accordance with PRISMA-ScR 2018 guidelines was conducted to identify suitable clinical trial protocols. PubMed and ClinicalTrials.gov were searched for trials published between 2020 and 2025, focusing on studies with full protocols in English that included surgical treatment of NSCLC. Surgical radicality and lymphadenectomy definitions provided in the protocols were extracted and evaluated for adherence to NCCN and IASLC guidelines. Each component was assigned a value of '1' if the criterion was met and '0' if it was not. These binary scores were subsequently used to assess the overall compliance with the guidelines.

Out of 563 records initially identified, 47 were ultimately included. Only 15% of studies fully met the radical resection criteria according to both the NCCN and IASLC guidelines. As for lymphadenectomy, 30% of studies adhered to the NCCN guidelines, while 15% followed the IASLC guidelines.

These findings highlight the persistent lack of a clear and uniform definition of radical resection in NSCLC amongst trial protocols. Such heterogeneity pose difficulty in interpretability and comparability of clinical data. It is of utmost importance to reinforce a trend toward standardization, for the sake of both patients and physicians.