Saving Lives in Thoracic Surgery: Balancing Oncological Radicality and Functional Preservation, Transitioning from Standard Pneumonectomy to Targeted Sublobar Resection

Abstract

This review chronicles the evolution of thoracic surgical interventions, from the standardized pneumonectomy to the precise approach of sublobar resections. It discusses the emergence and acceptance of minimally invasive and robot-assisted surgical techniques, highlighting their impact on improving outcomes beyond cancer and their influence on the surgical management of early-stage lung cancer. Evaluating historical developments alongside present methodologies, this review underscores the critical need for meticulous surgical planning and execution to optimize both oncological radicality and functional preservation. This evolution portrayed not only technical advancements but also a shift in the clinical approach towards tailored, organ-preserving methodologies, culminating in a contemporary framework promoting sublobar resections as the standard for specific patient profiles, signifying a new era of precision in thoracic surgery.

Keywords: lung cancer; minimally invasive surgery; oncological radicality; pneumonectomy; pulmonary function preservation; robot-assisted thoracic surgery; sublobar resection; thoracic surgery.

Figure 1

Evolving standards and paradigms in lung cancer surgery [7,8,9,10,11,12]. Legends: The red, yellow, and green lines indicate pneumonectomy, lobectomy, and sublobar resection, respectively, as surgical techniques. The purple line signifies non-surgical treatments such as stereotactic body radiotherapy. The length of the vertical lines, represented by narrow lines in corresponding colours, visually indicates the relative size of patient populations undergoing each procedure over time; this does not denote exact numerical values. Within the context of the gray bars, “low-risk” and “high-risk” specifically denote noncancer-related risks. “Pts” stands for patients.