What we know about surgical therapy in early-stage non-small-cell lung cancer: a guide for the medical oncologist

Abstract

Lung cancer remains the leading cause of death in cancer patients. The gold standard for the treatment of early-stage non-small-cell lung cancer is lobectomy with mediastinal lymph-node dissection or systematic lymph-node sampling. The evidence behind this recommendation is based on the sole randomized controlled trial conducted to date, done by the Lung Cancer Study Group and published in 1995, which found a superiority for lobectomy over sublobar resection with regard to local recurrence rate and improved survival. The population studied at that time were medically fit patients at low risk for surgery with a stage IA non-small-cell lung carcinoma, ie, a solitary tumor less than 3 cm in size. In practice, however, thoracic surgeons have continued to push the limit of a more conservative surgical resection in this patient population. Since then, several retrospective studies have attempted to identify the ideal population to benefit from sublobar resection without it affecting survival or local recurrence. Several variables have been studied, including tumor size, patient age, surgical approach, histological and radiological properties, and optimal surgical resection margin, as well as promising prognostic biomarkers. In this review, we summarize the data available in the literature regarding the surgical approach to patients with stage IA non-small-cell lung cancer studying all the aforementioned variables.

Achievements and futures of immune checkpoint inhibitors in non-small cell lung cancer

“…Surgery is the only radical treatment strategy for resectable NSCLC currently [60]. However, 5-year survival rate after surgery is low, vary from 19 to 73% [61].…”

Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases

“…Thoracic surgery is the optimal therapy for early or resectable lung cancer [ 1 , 2 ]; however, it remains an invasive and traumatic procedure for the patients, particularly for those with lung dysfunction or a poor health status [ 3 ]. Minimally invasive surgeries, including video-assisted thoracoscopic surgery (VATS), are preferred for early stage lung cancer but remain limited by side effects and surgical stress, with a morbidity of 20.8–34.1% after lung cancer surgery [ 4 , 5 ].…”

Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials

“… 1 , 2 Nowadays, surgical treatment is regarded not only as the optimal therapeutic measure for early-stage non-small-cell lung cancer (NSCLC), but also as a key component of multidisciplinary treatment for advanced-stage NSCLC. 3 , 4 Advances in the radiographic techniques and the prevalent practice of cancer screening have substantially increased the opportunity for early detection, helping to offer more effective therapeutic options to lung cancer patients. However, despite advances in surgical techniques and perioperative care, the morbidity rate still remains at 20.8%–34.1% in patients undergoing lung cancer surgery, as reported in recent literature.…”