Les standards de la prise en charge chirurgicale des cancers bronchiques non à petites cellules

Abstract

Primary lung cancer is responsible for the most cancer-related deaths in France: 30 000 deaths every year. The only curative treatment remains oncologic surgery. The objective of this article is to review actual standards in surgical treatment of non-small cell lung cancers.An initial assessment of operability is mandatory by a cardiac and respiratory evaluation. It is important to determine if the type of resection planned is compatible with the patient’s general condition: pneumonectomy, simple lobectomy, sleeve lobectomy, segmentectomy or wedge resection. The extent of curative surgical resection has evolved with the 8th edition of primary lung cancer classification and the new pathologic classification of adenocarcinomas.Different surgical approaches, with each their benefits and their disadvantages, are available for the surgeon to choose between: conventional thoracotomy, muscle-sparing thoracotomy, videothoracoscopic surgery and robotic-assisted surgery. Patient care is more and more oriented toward inclusion in enhanced recovery after surgery protocols.