Precision Oncology in Lung Cancer Surgery

Overall, precision in surgical oncology encompasses decision -making for perioperative therapy, refined operative techniques, optimal extent of dissection, and innovative tumor visualization methods. These advancements aim to improve patient outcomes, minimize complications, and provide personalized care in the modern era of lung cancer treatment. First, in terms of the perioperative treatment course, the decision between NAT and adjuvant AT is crucial. AT has shown improved survival in early -stage NSCLC compared with surgery alone. However, for stages II-IIIA, NAT has not demonstrated clear advantages over definitive chemoradiation. The latest guidelines suggest evaluating all patients preoperatively for NAT, considering resectability criteria and molecular analysis for personalized treatment. Second, precision in operative technique has evolved to minimize the site of entry and improve outcomes. VATS has been associated with decreased morbidity, shorter hospital stays, improved DFS, and better postoperative outcomes compared with traditional thoracotomy. Third, precision in the extent of dissection involves addressing concerns about sublobar resections. Studies have shown that a sublobar resection can achieve similar overall survival and DFS compared with lobectomy for early -stage NSCLC. The optimal LN yield for accurate staging remains uncertain, but recent updates require resection from specific hilar and mediastinal stations. Last, precision in tumor visualization has been aided by IMI techniques. IMI-probe-guided surgery uses fluorescent probes and NIR imaging to localize tumors and guide parenchymal -sparing dissection. This approach has shown promise in improving surgical precision.