Topics and challenges of lung cancer surgery

Abstract

Video-assisted thoracic surgery （VATS） is the mainstream surgical approach for primary lung cancer, but in recent years, single-port VATS and robot-assisted surgery are new options.　Regarding the extent of resection, a phase 3 trial showed that segmentectomy for lung cancers less than 2 cm in size is superior to lobectomy, which has been the conventional standard procedure, and segmentectomy has become one of the standard procedures.　In the future, the prevention of local recurrence during sublober resection will be a topic of discussion.　Transbronchial metallic coil marking developed at Tokushima University can achieve precise lung resection and prevent local recurrence.　We are also developing new visualization techniques to diagnose pleural invasion and lymph node metastasis during surgery.　For advanced lung cancer, we have adopted preoperative treatment with a combination of chemotherapy and immune checkpoint inhibitors, and have obtained good treatment outcomes.　In addition, we conduct preoperative simulations and surgical training to safely perform highly difficult surgeries.