Critères qualité de la résection chirurgicale et chirurgie d’épargne parenchymateuse: Quality criteria for lung cancer surgery and lung parenchymal preservation

Abstract

The quality of surgical treatment for non-small cell lung cancer (NSCLC), is based on oncological recommendations and should guide our daily surgical practice and clinical research, at a time when alternative ablative techniques are emerging, as well as multimodal medical care, with or without surgery. Quality criteria to perform this type of surgery can be found at different levels: quality of the surgical indication confirmed by multidisciplinary team (MDT) meeting, quality of resection linked with the surgeon’s expertise, quality of perioperative care, quality of the pathologist’s analysis and quality of long-term follow-up. Only the centres certified for cancer thoracic surgery are authorised to perform this type of surgery. For a patient with localised resectable NSCLC, the recommended treatment remains complete anatomical surgical resection associated with radical lymphadenectomy. This surgical procedure allows optimal locoregional tumour control and precise pathological staging (pTNM), offering a prognostic value. It is essential to determine the adjuvant strategy. In the absence of respiratory failure, lobectomy remains the gold standard for resection. However, recent studies have shown that segmentectomy may become a favoured option for resection of smaller tumours (2 centimetres of less) without lymph node invasion (N0). In any extent of parenchymal resection, the lymphadenectomy has to be identical and follow international recommendations. The ultimate objective of this surgery is patients’ long-term survival, directly correlated with all quality criteria, particularly complete resection (R0).© 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.