Abstract
Simple SummaryThe management strategy for the treatment of non-small-cell lung cancer (NSCLC) has been transformed by our improved understanding of the cancer biology and concomitant development of novel systemic therapies. Complete surgical resection of NSCLC continues to offer the best chance for cure or local and regional disease control, and with improvements in minimally invasive techniques and enhanced recovery, the morbidity associated with surgical resection has been reduced. Patient-centered multi-disciplinary discussions that consider surgical therapy are associated with improved outcomes. Provided with promising novel therapeutic modalities including immune checkpoint inhibitors with or without chemotherapy, stereotactic radiotherapy, and targeted systemic therapies, indications for surgery continue to evolve and have expanded to include selected patients with advanced and metastatic disease.With recent strides made within the field of thoracic oncology, the management of NSCLC is evolving rapidly. Careful patient selection and timing of multi-modality therapy to permit the optimization of therapeutic benefit must be pursued. While chemotherapy and radiotherapy continue to have a role in the management of lung cancer, surgical therapy remains an essential component of lung cancer treatment in early, locally and regionally advanced, as well as in selected, cases of metastatic disease. Recent and most impactful advances in the treatment of lung cancer relate to the advent of immunotherapy and targeted therapy, molecular profiling, and predictive biomarker discovery. Many of these systemic therapies are a part of the standard of care in metastatic NSCLC, and their indications are expanding towards surgically operable lung cancer to improve survival outcomes. Numerous completed and ongoing clinical trials in the surgically operable NSCLC speak to the interest and importance of the multi-modality therapy even in earlier stages of NSCLC. In this review, we focus on the current standard of care indications for surgical therapy in stage I-IV NSCLC as well as on the anticipated future direction of multi-disciplinary lung cancer therapy.
Highlights
Lung cancer affects an estimated 2 million new patients each year and is associated with 1.76 million deaths per year making it the leading cause of cancer-related death in the world [1]
The decision whether to perform a resection with minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS), robotic-assisted thoracoscopic surgery (RATS), or in an open manner remains associated with patient-centered factors [29,30] considering that both open or minimally invasive approaches show similar oncologic outcomes, with VATS being associated with longer operative time [31], but both minimally invasive approaches leading to shorter hospital stays [32]
Propensity-matched analysis showed no difference in perioperative complications, overall survival, or cancer-specific survival between lobectomy or sublobar resections
Summary
Lung cancer affects an estimated 2 million new patients each year and is associated with 1.76 million deaths per year making it the leading cause of cancer-related death in the world [1]. Surgical management of lung cancer remains the modality most likely to result in curative outcomes while providing locoregional disease control. Surgical techniques and approaches have been continuously improving along with the vast array of other compelling treatment modalities developed for lung cancer management. This has enabled more patients to undergo operations while minimizing post-operative morbidity and mortality.
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