Precision Surgery in NSCLC

SIMPLE SUMMARY: The introduction of new therapies for non-small cell lung cancer (NSCLC) has radically changed the point of view of thoracic surgeons, leading them to pay increasingly more attention not only to the clinical stage, but also to the genomic and molecular features of the disease and the potential for multimodality treatments. This is the concept of precision surgery in thoracic oncology. The aim of our paper is to summarize the changes in thoracic surgical practice that occurred after the introduction of immunotherapy and targeted therapy for the treatment of NSCLC. ABSTRACT: Non-small cell lung cancer (NSCLC) is still one of the leading causes of death worldwide. This is mostly because the majority of lung cancers are discovered in advanced stages. In the era of conventional chemotherapy, the prognosis of advanced NSCLC was grim. Important results have been reported in thoracic oncology since the discovery of new molecular alterations and of the role of the immune system. The advent of new therapies has radically changed the approach to lung cancer for a subset of patients with advanced NSCLC, and the concept of incurable disease is still changing. In this setting, surgery seems to have developed a role of rescue therapy for some patients. In precision surgery, the decision to perform surgical procedures is tailored to the individual patient; taking into consideration not only clinical stage, but also clinical and molecular features. Multimodality treatments incorporating surgery, immune checkpoint inhibitors, or targeted agents are feasible in high volume centers with good results in terms of pathologic response and patient morbidity. Thanks to a better understanding of tumor biology, precision thoracic surgery will facilitate optimal and individualized patient selection and treatment, with the goal of improving the outcomes of patients affected by NSCLC.