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Review
. 2021 Jul 23;13(15):3711.
doi: 10.3390/cancers13153711.

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art

Affiliations
Review

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art

François Montagne et al. Cancers (Basel). .

Abstract

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.

Keywords: enhanced postsurgical recovery; lung cancer; minimally invasive surgery; palliative supportive care; robotic-assisted thoracoscopic surgery; surgical diagnosis; video-assisted thoracoscopic surgery.

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Conflict of interest statement

J.-M.B. is Proctor for Intuitive Surgical, Baxter and Medtronic. F.M., F.G. and N.V.: none.

Figures

Figure 1
Figure 1
Early-stage lung cancer on screening CT scan. (A) Pure Ground glass-opacity (GGO) in the right upper lobe. (B) Lung cancer nodule, cT1b as a densified lung nodule.
Figure 2
Figure 2
Video-assisted and Robotic-assisted thoracoscopic surgeries. (A) Surgical skin incisions for a left lung resection by video-assisted thoracoscopic approach (VATS) and operators setting in the operating room. (B) da Vinci (Intuitive Surgical) Xi platform for robotic-assisted thoracoscopic surgery (RATS) and assistant surgeons near the patient during left lung surgery performed with the X platform.
Figure 3
Figure 3
Surgical options and treatments for resectable Stage I lung cancer. Surgical options and treatments according to lung cancer stage in the lung cancer Stage I group according to the 8th Edition of the TNM classification of lung cancers [83].
Figure 4
Figure 4
Multimodal approach to minimally invasive personalized tailored segmentectomy. Multimodal approach to minimally invasive personalized tailored segmentectomy in 3 steps. Step 1: Pre-operative imaging with CT scan and 3D reconstructions in order to identify anatomical variabilities to perform anatomical segmentectomy. Step 2: Pre or per-operative lung tumor marking by radiological technique combining CT scan mapping, and hook wire, dye marking, lipiodol or coil; or bronchoscopy technique with virtual endoscopy and ultra-thin probes allowing dye marking or fluoroscopic marking with indocyanine green. Step 3: Planned and controlled minimally invasive segmentectomy with planning validation, guided resection and the identification or the intersegmental plan using fluoroscopic marking during a VATS or a RATS approach.
Figure 5
Figure 5
Multimodal treatment and surgical options for stage II NSCLC excluding T3 N0. Surgical options according to lung cancer stage in the lung cancer Stage II group excluding T3 N0, according to the 8th Edition of the TNM classification of Lung Cancer [83].
Figure 6
Figure 6
Multimodal treatment and surgical options for cT3 and stage III NSCLC. Surgical options according to lung cancer stage in the lung cancer Stage III group and cT3, according to the 8th Edition of the TNM Classification of Lung Cancer [83].

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