The Evolving Concept of Complete Resection in Lung Cancer Surgery

Abstract

Different definitions of complete resection were formulated to complement the residual tumor (R) descriptor proposed by the American Joint Committee on Cancer in 1977. The definitions went beyond resection margins to include the status of the visceral pleura, the most distant nodes and the nodal capsule and the performance of a complete mediastinal lymphadenectomy. In 2005, the International Association for the Study of Lung Cancer (IASLC) proposed definitions for complete, incomplete and uncertain resections for international implementation. Central to the IASLC definition of complete resection is an adequate nodal evaluation either by systematic nodal dissection or lobe-specific systematic nodal dissection, as well as the integrity of the highest mediastinal node, the nodal capsule and the resection margins. When there is evidence of cancer remaining after treatment, the resection is incomplete, and when all margins are free of tumor, but the conditions for complete resection are not fulfilled, the resection is defined as uncertain. The prognostic relevance of the definitions has been validated by four studies. The definitions can be improved in the future by considering the cells spread through air spaces, the residual tumor cells, DNA or RNA in the blood, and the determination of the adequate margins and lymphadenectomy in sublobar resections.

Perioperative Outcomes of Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy After Neoadjuvant Chemoimmunotherapy in Resectable NSCLC

“…Patients who underwent conversion from VATS to open thoracotomy were also included into open thoracotomy group. Surgery with curative-intent was performed in all patients, and radical (R0) resection was defined as microscopically negative margins, resection of at least three N1 and three N2 lymph node stations including station 7, and no extracapsular extension in resected lymph nodes ( 18 ). The chest tube was removed when no air leak was clearly confirmed, and the volume of drainage was <200 mL/d.…”

A real‐world comparison between neoadjuvant chemoimmunotherapy and chemotherapy alone for resectable non‐small cell lung cancer

“…Some patients received pulmonary resection with systemic lymphadenectomy via minimally invasive surgery (video‐assisted thoracic surgery [VATS]) or traditional open thoracotomy. Definitive resection was defined according to the standards reported by Rami‐Porta et al 11 …”

“…Some patients received pulmonary resection with systemic lymphadenectomy via minimally invasive surgery (video-assisted thoracic surgery [VATS]) or traditional open thoracotomy. Definitive resection was defined according to the standards reported by Rami-Porta et al 11 Postoperative treatment was administered according to the recovery condition of each patient, treatment-related adverse events (TRAEs), and pathological responses after the discussion of the multidisciplinary team. In the PD-1 + Chemo group, adjuvant PD-1 inhibitors might be recommended until month 12 after four cycles of chemoimmunotherapy (including neoadjuvant and adjuvant chemoimmunotherapy in total).…”

Nomograms for intraoperative prediction of lymph node metastasis in clinical stage IA lung adenocarcinoma

“…LML, compared with systematic mediastinal lymphadenectomy (SML), is associated with reduced damage of adjacent mediastinal structures, lower incidence of complications and shortened hospitalization 4,10 . However, inadequate mediastinal nodal dissection may underestimate the nodal stage of some N2‐positive patients, thus depriving these patients of the opportunity to receive adjuvant therapy 11,12 . Besides, when applying sublobar resection, it is essential to confirm that there is no LN metastasis 13,14 .…”