State of the art and new perspectives in surgical treatment of lung cancer: a narrative review

BACKGROUND AND OBJECTIVE: Lung cancer is the leading cause of cancer-related deaths worldwide, and its incidence has increased over the past two decades. The standard care for stage I, stage II, and selected cases of stage IIIA non-small cell lung cancer (NSCLC) is surgical resection; in some cases, patients may be offered adjuvant systemic therapy after surgical resection. Patients with lung cancer presenting with distant metastases belong to stage IV: in this setting, some carefully selected patients may benefit from surgery within a multimodality approach. METHODS: We performed a comprehensive, non-systematic review of the latest literature to define the present role of surgery in lung cancer treatment. KEY CONTENT AND FINDINGS: The literature review disclosed a pivotal role of surgery in early stage lung cancer and a complimentary role in locally advanced lung cancer; in very selected cases, surgery might be considered in oligometastatic disease. CONCLUSIONS: Surgical treatment of lung cancer still plays a pivotal role in early stages of the disease while, in locally advanced stages, it may contribute to improve overall survival in combination with medical treatments and radiotherapy. More recently, an effective role of surgery has been advocated in carefully selected oligometastatic patients with encouraging initial results.