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Cancers
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Surgical Management of Non-Small Cell Lung Cancer
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Surgical Management of Non-Small Cell Lung Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 15 December 2025 | Viewed by 1469

Special Issue Editor

Dr. József Furák

E-Mail Website
Guest Editor
Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
Interests: non-small cell lung cancer; surgery

Special Issue Information

Dear Colleagues,

It is a great honor for me to bring this Special Issue to your attention. With this publication, we aim to summarize the current practice and topics of research in the field of surgical treatment of non-small cell lung cancer.

In this Special Issue, original articles and reviews are welcome on the following topics:

  1. Neoadjuvant, adjuvant, or perioperative treatment of NSCLC;
  2. Preoperative investigation of the surgical treatment of NSCLC;
  3. Segmentectomy for NSCLC;
  4. Minimally invasive (VATS and robotic) surgery for NSCLC;
  5. Role of STAS in surgery for NSCLC;
  6. Innovative surgeries for NSCLC;
  7. Main airway surgery for NSCLC.

I look forward to receiving your contributions.

Dr. József Furák
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • non-small cell lung cancer
  • surgery
  • treatment
  • segmentectomy

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Published Papers (4 papers)

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Research

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17 pages, 679 KB  
Article
Oncological Outcome of Minimally Invasive Single-Port Segmentectomy Compared to Lobectomy for Stage IA Lung Cancer
by Boris Kostovski, Konstantinos Gioutsos, Michail Galanis, Francine Binelli, Thanh-Long Nguyen and Patrick Dorn
Cancers 2025, 17(21), 3431; https://doi.org/10.3390/cancers17213431 (registering DOI) - 25 Oct 2025
Abstract
Background and Objectives: Lobectomy has traditionally been the gold standard for surgical treatment of early-stage non-small cell lung cancer (NSCLC). However, recent randomized trials suggest anatomical segmentectomy may offer comparable outcomes for selected patients with small, peripheral tumors. The role of segmentectomy in [...] Read more.
Background and Objectives: Lobectomy has traditionally been the gold standard for surgical treatment of early-stage non-small cell lung cancer (NSCLC). However, recent randomized trials suggest anatomical segmentectomy may offer comparable outcomes for selected patients with small, peripheral tumors. The role of segmentectomy in stage IA3 tumors remains less apparent in the context of video-assisted thoracoscopic surgery. Methods: This retrospective study analyzed 232 patients with pathological stage IA NSCLC who underwent uniportal anatomical segmentectomy (n = 160) or lobectomy (n = 72). Clinicopathological characteristics, recurrence rates, and overall survival (OS) were compared, with subgroup analysis for IA1–IA3 tumors. Results: The 5-year OS was 76.9% for segmentectomy and 87.5% for lobectomy (p = 0.105). Recurrence occurred in 15.8% of segmentectomy patients and 11.3% of lobectomy patients. In IA3 tumors, recurrence rates were higher after segmentectomy (23.5% vs. 18.2%), though not statistically significant. Lymphatic invasion was an independent predictor of mortality. No significant differences were found in tumor size, histologic subtype, or nodal involvement between groups. Conclusions: Uniportal anatomical segmentectomy may be a feasible alternative to lobectomy for stage IA NSCLC, especially for tumors ≤ 2 cm. For IA3 tumors, caution is advised given a trend toward worse outcomes. Careful patient selection and adherence to oncologic principles are essential. Full article
(This article belongs to the Special Issue Surgical Management of Non-Small Cell Lung Cancer)
15 pages, 979 KB  
Article
Visceral Pleural Invasion as a Determinant of Surgical Strategy in Non–Small Cell Lung Cancer: A Multicenter Study
by Wakako Nagase, Yujin Kudo, Takuya Nagashima, Takahiro Mimae, Yoshihisa Shimada, Masaru Hagiwara, Masatoshi Kakihana, Tatsuo Ohira, Yoshihiro Miyata, Hiroyuki Ito, Morihito Okada and Norihiko Ikeda
Cancers 2025, 17(20), 3382; https://doi.org/10.3390/cancers17203382 - 20 Oct 2025
Viewed by 150
Abstract
Background: Visceral pleural invasion (VPI) has traditionally been regarded as a negative prognostic indicator in non-small-cell lung cancer (NSCLC). However, with the increasing adoption of sublobar resection for small-sized NSCLC, the clinical significance of VPI is being fundamentally reassessed. Specifically, it remains uncertain [...] Read more.
Background: Visceral pleural invasion (VPI) has traditionally been regarded as a negative prognostic indicator in non-small-cell lung cancer (NSCLC). However, with the increasing adoption of sublobar resection for small-sized NSCLC, the clinical significance of VPI is being fundamentally reassessed. Specifically, it remains uncertain whether VPI is indicative of tumor size or represents distinct metastatic behavior. Methods: We conducted a retrospective comprehensive multicenter study involving 2464 patients with pathologically confirmed NSCLC ≤ 3 cm who underwent complete resection at three Japanese institutions. The prevalence, metastatic patterns, and prognostic impact of VPI were systematically evaluated, with particular focus on histological growth patterns. Results: VPI was identified in 370 patients (15%). Notably, VPI-positive tumors demonstrated a doubled incidence of lymph node metastasis (31% vs. 15%, p < 0.001) and a distinct metastatic profile characterized by preferential hilar spread (#12, 16.9%) and an increased risk of skip N2 metastasis (4.0% vs. 2.0%). Five-year recurrence-free survival was significantly reduced in the VPI group (33.7% vs. 50.6%, respectively). Conversely, adenocarcinomas with lepidic characteristics demonstrated a minimal risk of VPI or nodal metastasis, with incidences of 2% and 1%, respectively. This finding highlights the heterogeneity in the biological aggressiveness of small-sized NSCLC. Conclusions: Our findings suggest that VPI is not merely a histopathological descriptor but also acts as a clinically significant indicator of aggressive metastatic behavior, potentially enhancing surgical and staging approaches beyond just considering tumor size. With the increasing adoption of sublobar resection for small-sized NSCLC, recognizing that VPI appears to be associated with predominant hilar involvement and an elevated risk of skip N2 metastasis may help refine decisions on the extent of lung and lymph node resection. Full article
(This article belongs to the Special Issue Surgical Management of Non-Small Cell Lung Cancer)
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15 pages, 2051 KB  
Article
Comparison of the Diagnostic Efficiency of Mediastinal Lymph Node Endobronchial and Endoesophageal Ultrasound with Transcervical Extended Mediastinal Lymphadenectomy in Operable Non-Small Cell Lung Cancer
by Michal Wilkojc, Pawel Gwozdz, Sylweriusz Kosinski, Juliusz Pankowski, Artur Szlubowski, Aleksandra Kiszka-Wilkojc, Wojciech Czajkowski, Robert Kwiatkowski and Marcin Zielinski
Cancers 2025, 17(13), 2207; https://doi.org/10.3390/cancers17132207 - 1 Jul 2025
Cited by 1 | Viewed by 759
Abstract
Objectives: The aim of the study was to compare the diagnostic efficiency between combined endobronchial ultrasound (EBUS)/endoesophageal ultrasound (EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) for preoperative staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC). Material and Methods: [...] Read more.
Objectives: The aim of the study was to compare the diagnostic efficiency between combined endobronchial ultrasound (EBUS)/endoesophageal ultrasound (EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) for preoperative staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC). Material and Methods: Between June 2011 and December 2017, a single-institution prospective randomized trial was conducted, and 250 patients with cytologically confirmed NSCLC, clinical stages cI–IIIA, were included. Positron emission tomography/computed tomography (PET/CT) was performed in all patients. After exclusions, 204 patients were randomized into the EBUS/EUS or TEMLA arms. Patients without N2/N3 metastases after mediastinal staging underwent surgery. The diagnostic yield and complication rates of the EBUS/EUS and TEMLA groups were compared. Results: There were 103 patients in the EBUS/EUS group, and N2 metastases were found in nine cases (8.7%). Ninety-four patients underwent surgery; in six cases, previously unsuspected N2 metastases were revealed. One hundred and one patients were randomized to the TEMLA group, which detected N2/N3 metastases in 15 cases (15.1%). Three patients were not operated on due to postoperative complications following TEMLA. Eighty-three patients underwent surgery, and a single N2 metastatic nodule was detected in one case. The diagnostic sensitivity, specificity, accuracy, PPV, and NPV were 94%, 100%, 99%, 100%, and 99% for TEMLA, respectively, and 60%, 100%, 94%, 100%, and 94% for EBUS/EUS, respectively. There was a significant difference in sensitivity (60% vs. 94%) between the EBUS/EUS and TEMLA groups in favor of the TEMLA group. Postoperative complications occurred in 6/101 (6%) patients after TEMLA, while no complications were observed in the EBUS/EUS group. Conclusions: TEMLA demonstrated superior sensitivity for detecting N2/3 disease compared to EBUS/EUS in terms of diagnostic performance for mediastinal staging of cI–IIIA NSCLC. Due to its more invasive nature, TEMLA was associated with a higher number of complications compared with EBUS/EUS. Full article
(This article belongs to the Special Issue Surgical Management of Non-Small Cell Lung Cancer)
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Review

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14 pages, 2035 KB  
Review
Multidisciplinary Perspective of Spread Through Air Spaces in Lung Cancer: A Narrative Review
by Riccardo Orlandi, Lorenzo Bramati, Maria C. Andrisani, Giorgio A. Croci, Claudia Bareggi, Simona Castiglioni, Francesca Romboni, Sara Franzi and Davide Tosi
Cancers 2025, 17(20), 3374; https://doi.org/10.3390/cancers17203374 - 19 Oct 2025
Viewed by 294
Abstract
Spread Through Air Spaces (STAS) is an emerging pattern of tumor invasion in lung cancer, first recognized by the World Health Organization in 2015. This narrative review examines STAS from a multidisciplinary perspective, integrating pathologic, radiologic, oncologic, and surgical points of view, together [...] Read more.
Spread Through Air Spaces (STAS) is an emerging pattern of tumor invasion in lung cancer, first recognized by the World Health Organization in 2015. This narrative review examines STAS from a multidisciplinary perspective, integrating pathologic, radiologic, oncologic, and surgical points of view, together with molecular biology to assess its clinical significance, diagnostic challenges, and therapeutic implications. Pathologically, STAS is characterized by tumor cells floating beyond the main tumor, contributing to recurrence and poor prognosis. Radiologic advancements suggest potential imaging markers for STAS, such as spiculation, the absence of an air bronchogram, solid tumor components, as well as high fluorodeoxyglucose uptake, though definitive preoperative identification remains challenging. Oncologic studies link STAS to aggressive tumor behavior and lympho-vascular invasion, suggesting a role for adjuvant chemotherapy even in the earliest stages of disease; furthermore, specific molecular alterations have been discovered, including EGFR wild-type status and ALK/ROS1 rearrangements together with high Ki-67 expression, tumor necrosis, and alterations in cell adhesion proteins like E-cadherin. Surgical aspects highlight the increased risk of recurrence following limited resection, raising concerns about optimal surgical strategies. The debate over STAS as a true invasion mechanism versus an artifact from surgical handling underscores the need for standardized pathological evaluation. This review aims to refine STAS detection, integrate it into multidisciplinary treatment decision-making, and assess its potential as a staging criterion in lung cancer management. Full article
(This article belongs to the Special Issue Surgical Management of Non-Small Cell Lung Cancer)
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