Sublobar resection for early-stage non-small cell lung cancer and current advances with immunotherapy in multimodality treatment of resectable non-small cell lung cancer

Abstract: The two significant advances in the field of thoracic surgery in the last few years are the validation of sublobar resection for early-stage non-small cell lung cancer (NSCLC) and the integration of surgery in multimodality treatment protocols, including immunotherapy. The long-standing belief in the superiority of lobectomy over limited resection for early-stage NSCLC was challenged by the JCOG0802/WJOG4607L trial and the CALGB140503 trial, which compared lobectomy to sublobar resection. The consistency of outcomes between the two newly published trials is reassuring despite variations in study design. Their results confirm that sublobar resection, whether by wedge resection or anatomical segmentectomy, is an oncologically valid therapeutic strategy for this subset of NSCLC patients with clinical T1aN0 disease. Significant changes have been made in the treatment landscape of resectable NSCLC, especially after the development and approval of immune checkpoint inhibitors (ICI). These changes are shaping a new era in the field, with ICI being added to the existing treatment protocols combined with traditional systemic therapies. The introduction of ICI has created a whole spectrum of new treatment algorithms, marking a significant shift in our approach to NSCLC treatment. The advancements in lung cancer treatment discussed in this paper, encompassing both issues, have the potential to enhance treatment outcomes.