Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management—State of the Art

SIMPLE SUMMARY: Lung cancer is a heterogeneous disease, making it a complex and challenging condition to diagnose and treat effectively. However, recent advances have been made in surgery and perioperative management as well as in the emergence of new therapies (targeted therapy and immunotherapy). These novel treatment approaches have fundamentally altered the course of the disease, offering new hope and improved outcomes for patients. While surgery traditionally played a role mainly in the initial phases of lung cancer, its potential benefits are now being considered at various stages of the disease. The objective of this review is to provide a comprehensive description of the latest surgical approaches in lung cancer. We aim to highlight the importance of integrating these modalities within a patient-centered and personalized treatment pathway. ABSTRACT: Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.