2026 Volume 85 Issue 4 Pages 173-179
Background: Lung cancer management has undergone a remarkable paradigm shift with advances in imaging, minimally invasive surgery, targeted therapies, and immune checkpoint inhibitors. This review summarizes recent changes in surgical strategies and perioperative treatments.
Methods and Results: For early-stage lung cancer, the concept of the consolidation-to-tumor ratio (CTR) and the findings of the JCOG0201 study enabled preoperative prediction of pathological noninvasive adenocarcinoma. Subsequent trials, including JCOG0804, JCOG0802/WJOG4607L, and JCOG1211, demonstrated the feasibility and efficacy of limited resection, leading to an expanded role for wedge resection and segmentectomy in small peripheral lung cancers. In stage II-III disease, perioperative treatment strategies have evolved beyond platinum-based chemotherapy. The IMpower010 trial established the role of adjuvant atezolizumab after complete resection, while the CheckMate 816 trial demonstrated the efficacy of neoadjuvant chemoimmunotherapy. Furthermore, the KEYNOTE-671 and AEGEAN trials showed significant benefits of perioperative immunotherapy combining preoperative and postoperative treatment. For patients with EGFR-mutated non-small cell lung cancer, the ADAURA trial demonstrated substantial improvements in disease-free and overall survival with adjuvant osimertinib, establishing targeted therapy as a new standard of care.
Conclusions: Modern thoracic oncology is characterized by the optimization of surgical extent and individualized perioperative systemic therapy. Thoracic surgeons are now required to integrate surgical expertise with a comprehensive understanding of tumor biology, targeted therapies, immunotherapy, and multidisciplinary treatment strategies to achieve optimal patient outcomes.
