Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Department of Thoracic Surgery, Marmara University, Istanbul, Turkey.
Eur Respir Rev. 2024 Mar 20;33(171). doi: 10.1183/16000617.0195-2023. Print 2024 Jan 31.
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
手术仍然是早期非小细胞肺癌多模式根治治疗的重要组成部分。此外，胸外科是肺癌肿瘤委员会涉及的关键专业之一。鉴于可切除性这一关键概念，外科医生在多学科小组中的重要性日益增加，可切除性是患者在试验和实际实践中接受新辅助/辅助治疗选择的基础。这篇综述涵盖了胸外科肿瘤医生日常实践中相关的一些主题，肿瘤委员会的非外科成员也应该了解这些主题。它涵盖了以下主题：根据不断改进的非手术治疗选择，为手术候选人进行术前选择，以确定不适合手术的患者是否可以从中受益；可切除性的定义，这对于将患者纳入试验并选择最合适的根治性治疗非常重要；手术入路和手术扩展的影响，随着微创手术、亚肺叶切除术和肺实质保留袖状切除术的发展，避免了全肺切除术。
