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

Cancers · 6 authors, 6 centres

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AGENT 01 · STRUCTURED SUMMARY

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TL;DR

This narrative review describes the evolving role of thoracic surgery in non-small cell lung cancer (NSCLC) management, highlighting its integration with novel therapies like immunotherapy and targeted therapy across different disease stages. It discusses the safety and feasibility of salvage surgery for selected patients who have progressed on or after immunotherapy.

Full summary

1,152 CHARS

This narrative review summarizes the modern, multidisciplinary approach to non-small cell lung cancer (NSCLC), emphasizing thoracic surgery's role beyond early stages. The review discusses advances in minimally invasive surgery and perioperative care, the impact of immunotherapy and targeted therapies, and the concept of precision surgery. A key focus is salvage surgery, defined as lung resection in patients with initially unresectable or metastatic disease who have received prior treatments like immunotherapy. The text states that several studies have demonstrated the safety and feasibility of salvage surgery after immunotherapy, with postoperative complication rates ranging from 16% to 43% and a 90-day mortality rate between 0% and 9%. However, the review notes significant limitations in the existing evidence, including the retrospective nature of the studies, case series design, heterogeneity in procedures, and the highly selected patient populations reported. The implications are that while salvage surgery is a viable option in selected cases, its application requires careful patient selection within a multidisciplinary framework.

STUDY TYPE

narrative_review

SPECIALTY

oncology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10452134

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

Cancers

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ABSTRACT

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.

CITATION EXPORT

Benjamin Bottet, Nicolas Piton, Jean Selim et al.. Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management—State of the Art. Cancers. (2023). https://doi.org/10.3390/cancers15164039

AUTHORS

6 · 6 CENTRES

Benjamin Bottet, Nicolas Piton, Jean Selim, Matthieu Sarsam, Florian Guisier, Jean-Marc Baste

1Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; [email protected] (B.B.); [email protected] (M.S.)
2Department of Pathology, UNIROUEN, INSERM U1245, CHU Rouen, Normandy University, F-76000 Rouen, France; [email protected]
3Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France; [email protected]
4INSERM EnVI UMR 1096, University of Rouen Normandy, F-76000 Rouen, France
5Department of Pneumology, CHU Rouen, 1 Rue de Germont, F-76000 Rouen, France; [email protected]
6Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France

EDITOR / REVIEWER

Marco Alifano