Abstract
Simple SummaryLung cancer evolutions, innovative systemic treatments, minimally invasive thoracic surgery approaches and perioperative medical care have changed the role of surgery in the treatment of lung cancer. Pre-invasive and early-stage lung cancer, and conversely, advanced and metastatic tumors can be treated by innovative imaging-guided resection, minimally invasive approach or hybrid approach with very good short-term outcomes, enhanced recovery and preserved long-term survival. Considering lung cancer as a chronic disease, surgery must anticipate future disease evolution by sparing lung tissue and preserving lung function, while an oncologic complete resection must be performed. Surgery could also be valuable when recurrences occur or for selected palliative conditions. This article outlines present indications and future perspectives of lung surgery in lung cancer.Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients’ characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients’ comfort.
Highlights
Lung cancer is the leading cause of cancer mortality worldwide with 2.09 million newly diagnosed cases in 2018 and 1.76 million people related deaths [1,2]
Surgeons must do more than just performing the best oncologic resection, with the best short and long-term outcomes, they must promote good health, by encouraging patients to stop their bad lifestyle habits, and to start pre-operative functional rehabilitation in order to improve functional outcomes leading to reduced post-operative complications
Due to increased frailty and operative risks in elderly patients, segmentectomy is discussed as an alternative to lobectomy in early-stage Non-small cell lung cancers (NSCLC) [77], allowing a precise diagnosis associated with lymph node dissection (LND) with no increase in the morbiditymortality of this procedure [78,79] and treatment or a shift to stereotaxic body radiotherapy (SBRT) with good results
Summary
Lung cancer is the leading cause of cancer mortality worldwide with 2.09 million newly diagnosed cases in 2018 and 1.76 million people related deaths [1,2]. Lung cancer is “a generic term” of a very heterogenous disease by its histology, its molecular intrinsic characteristics and variabilities, its clinical stages at diagnosis, and patient conditions This heterogeneity determines which treatment, combinations of treatment, or multimodality therapy (MMT) plan can be proposed in a complete treatment pathway integrating surgery. Approximately 70%, are diagnosed at an advanced stage [3], but the increasing use of screening programs and other follow-up have led to the earlier diagnosis of less-advanced stages, reducing lung cancer mortality [4,5] These earlier and potentially resectable tumors raise questions regarding lung sparing surgery, minimally invasive approaches, the type of lymph node dissection (LND), and the best surgical treatment for patients with low respiratory capacity or elderly patients, compared to non-ablative local therapy. We will review some aspects of lung cancer surgery for non-small cell lung cancer (NSCLC), its present indications, and future perspectives according to the outline presented above
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