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Cancers
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State-of-the-Art Surgical Treatment for Lung Cancers
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State-of-the-Art Surgical Treatment for Lung Cancers

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

Deadline for manuscript submissions: 31 July 2026 | Viewed by 1840

Special Issue Editors

Dr. Andrea Axtell

E-Mail Website
Guest Editor
School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
Interests: thoracic oncology; lung cancer; robotic surgery; tracheal surgery
Prof. Dr. Malcolm DeCamp

E-Mail Website
Guest Editor
Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Interests: thoracic oncology; lung cancer; lung volume reduction surgery

Special Issue Information

Dear Colleagues,

Lung cancer care is rapidly evolving, with major breakthroughs in screening, surgical techniques, chemotherapy and immunotherapy regimens, and targeted therapies transforming the therapeutic landscape over the last decade. State-of-the-art advances in lung cancer surgery include minimally invasive technologies that offer reduced pain, shorter hospital stays, and faster recovery. Parenchymal-sparing operations are now routinely offered for appropriate patients with early-stage lung cancer, and research continues to evolve, guiding operative extent based on histologic subtypes and tumor characteristics. Additionally, advances in imaging technologies are improving detection and localization of tumors, and AI is being utilized to personalize treatment plans and improve outcomes.

In this Special Issue of Cancers, we welcome original research articles or comprehensive review articles focusing on novel techniques for lung cancer resection, including minimally invasive technologies; extent of resection in early-stage lung cancer; review of neoadjuvant and adjuvant treatment paradigms; approach to complex resections, including extended thoracic and airway resection and reconstruction; and the use of AI in lung cancer surgery. I hope that such a collection of studies will increase our knowledge of advances in lung cancer surgery and provide powerful tools to expand our field and care for our patients.

Dr. Andrea Axtell
Prof. Dr. Malcolm DeCamp
Guest Editors

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 250 words) can be sent to the Editorial Office for assessment.

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

  • lung cancer
  • lung cancer surgery
  • sublobar resection
  • segmentectomy
  • minimally invasive surgery
  • robotic surgery
  • tumor localization
  • mediastinal staging

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Published Papers (4 papers)

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Review

16 pages, 755 KB  
Review
The Paradigm Shift in Clinical Stage II Non-Small-Cell Lung Cancer Management: A Comprehensive Review of Optimal Surgical and Systemic Approaches
by Tyler W. Wilson and Jessica S. Donington
Cancers 2026, 18(11), 1680; https://doi.org/10.3390/cancers18111680 - 22 May 2026
Abstract
Lung cancer is one of the most common cancers worldwide, with non-small-cell lung cancer (NSCLC) being the most prevalent type. While surgical resection followed by adjuvant platinum-based chemotherapy has been the standard for curative-intent therapy for clinical stage II NSCLC since 2005, disappointing [...] Read more.
Lung cancer is one of the most common cancers worldwide, with non-small-cell lung cancer (NSCLC) being the most prevalent type. While surgical resection followed by adjuvant platinum-based chemotherapy has been the standard for curative-intent therapy for clinical stage II NSCLC since 2005, disappointing 5-year survival prompted the exploration of newer systemic therapies. In recent years, several landmark trials increasingly support the use of immunotherapy and molecular targeted treatments. The evidence for neoadjuvant chemoimmunotherapy is exciting, but the transition from a surgery-first approach to a new standard of care carries important challenges, including increased surgical attrition, intraoperative technical difficulty, and delays in care. This article provides a comprehensive review of the optimal treatments and emerging therapies for resectable stage II NSCLC. By systematically analyzing recent advances and challenges in NSCLC treatment strategies, we aim to highlight a paradigm shift toward a more molecularly guided, individualized treatment sequence in stage II NSCLC care, with the goal of maximizing each patient’s curative potential. Full article
(This article belongs to the Special Issue State-of-the-Art Surgical Treatment for Lung Cancers)
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23 pages, 1686 KB  
Review
State-of-the-Art Mediastinal Staging in Non-Small-Cell Lung Cancer: Integration of Combined Endosonographic Techniques with Updated IASLC TNM 9th Classification
by Omar Alkathiri and Moishe Liberman
Cancers 2026, 18(10), 1666; https://doi.org/10.3390/cancers18101666 - 21 May 2026
Abstract
The objective of this review is to evaluate the role of combined endobronchial and esophageal endosonography in mediastinal staging and to define its clinical implications within the proposed IASLC TNM 9th edition framework. Mediastinal staging remains a critical step in the management of [...] Read more.
The objective of this review is to evaluate the role of combined endobronchial and esophageal endosonography in mediastinal staging and to define its clinical implications within the proposed IASLC TNM 9th edition framework. Mediastinal staging remains a critical step in the management of non-small cell lung cancer (NSCLC), as it directly impacts treatment planning, surgical decision-making, and overall prognosis. For many years, mediastinoscopy was considered the standard approach; however, in routine practice, it has largely been replaced by less invasive techniques. Endobronchial Ultrasound (EBUS) and Endoscopic Ultrasound (EUS) have become widely adopted because they allow real-time sampling of lymph nodes with good accuracy and a low complication rate. In clinical settings, these techniques are often used together rather than separately, as each provides access to different nodal stations. This combined approach improves diagnostic yield and reduces the number of patients who require surgical staging. At the same time, recent updates in the IASLC TNM classification, including the proposed 9th edition, have introduced more detailed nodal categories, making accurate tissue confirmation even more important in daily practice. In this review, we summarize the current use of combined EBUS and EUS in mediastinal staging, focusing on their practical advantages, limitations, and roles across different clinical scenarios. We also discuss their relevance in the context of molecular testing and evolving treatment strategies. Despite their strengths, there are situations in which negative results should be interpreted with caution and confirmed surgically. Overall, these techniques have reshaped the approach to mediastinal staging and are now central to modern lung cancer care. Full article
(This article belongs to the Special Issue State-of-the-Art Surgical Treatment for Lung Cancers)
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Figure 1

20 pages, 818 KB  
Review
STAS More than a Prognostic Marker—An Evolving Factor in Operative and Adjuvant Treatment Decisions in Early-Stage NSCLC
by Joshua R. Brady and Andrea L. Axtell
Cancers 2026, 18(9), 1414; https://doi.org/10.3390/cancers18091414 - 29 Apr 2026
Viewed by 571
Abstract
Since tumor spread through air spaces (STAS) was first described over a decade ago, numerous studies have demonstrated that it is a high-risk prognostic feature in non-small cell lung cancer (NSCLC). However, due to preoperative and intraoperative limitations in pathologic diagnosis, STAS is [...] Read more.
Since tumor spread through air spaces (STAS) was first described over a decade ago, numerous studies have demonstrated that it is a high-risk prognostic feature in non-small cell lung cancer (NSCLC). However, due to preoperative and intraoperative limitations in pathologic diagnosis, STAS is generally diagnosed following curative intent resection. While STAS should influence NSCLC treatment strategy—particularly upfront surgical decision-making—postoperative diagnosis of STAS has heretofore limited this possibility. While limited to retrospective studies, the current evidence suggests that patients with tumor STAS should undergo a more extensive anatomical resection—preferably a lobectomy, if they are candidates. These results are particularly important in the setting of the results of the JCOG0802 and CALGB 140503 randomized controlled trials which have begun a paradigm-shift toward sublobar resections for early-stage NSCLC, which may not hold similar benefit for early-stage STAS+ disease. The aims of this review are to: (1) detail the current evidence concerning choice of resection extent for STAS+ disease, (2) summarize the current evidence about optimum surgical margins for STAS+ disease, (3) detail the potential role for adjuvant chemotherapy in early-stage STAS+ disease, (4) assess the current limitations in preoperative STAS risk prediction and intraoperative STAS detection, and (5) highlight promising AI-based advancements which will allow surgeons to risk-stratify STAS probability or confirm STAS status intraoperatively. The main limitation of this review is the reliance on retrospective studies as there is a current lack of prospective or randomized data within STAS+ NSCLC, particularly regarding optimal resection strategy for STAS+ disease. Full article
(This article belongs to the Special Issue State-of-the-Art Surgical Treatment for Lung Cancers)
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Figure 1

23 pages, 378 KB  
Review
Long-Term Oncological Outcomes of Minimally Invasive Surgery in Non-Small Cell Lung Cancer: An Updated Review
by Marco Donatello Delcuratolo, Michele Piazzolla, Doroty Sampietro, Lucia Anna Muscarella, Concetta Martina Di Micco, Antonella Centonza, Federico Pio Fabrizio, Domenico Trombetta, Franco Morelli, Francesco Passiglia and Paola Parente
Cancers 2026, 18(5), 798; https://doi.org/10.3390/cancers18050798 - 28 Feb 2026
Cited by 1 | Viewed by 794
Abstract
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancers, and surgical resection is the gold-standard treatment for resectable disease. Minimally invasive surgery (MIS), which includes video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), has emerged as an alternative option [...] Read more.
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancers, and surgical resection is the gold-standard treatment for resectable disease. Minimally invasive surgery (MIS), which includes video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), has emerged as an alternative option to thoracotomy, with the aim of minimizing perioperative morbidity without compromising oncological efficacy. This narrative review evaluates long-term oncological outcomes (overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS)) in patients with NSCLC at different stages who underwent MIS. Retrospective and prospective studies, as well as meta-analyses, are included. VATS has shown comparable and, in many cases, superior oncological outcomes compared to open surgery, with more evident benefits in the early stages of the disease. Although mainly in retrospective studies, RATS has demonstrated efficacy in terms of oncological outcomes comparable to open surgery, even in advanced stages or complex resections. With regard to the direct comparison between VATS and RATS, the two MIS techniques have shown similar OS rates, albeit some prospective data and meta-analyses suggest a potential DFS advantage for RATS. MIS is a safe and effective surgical approach in terms of oncological outcomes for resectable NSCLC; nevertheless, it will be necessary to await the results of further randomized studies currently ongoing to better define the long-term benefits of each technique. Full article
(This article belongs to the Special Issue State-of-the-Art Surgical Treatment for Lung Cancers)
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