Search Results (884)

Non-small cell lung cancer (NSCLC) accounts for nearly 85% of lung cancer cases and remains a leading cause of cancer-related mortality worldwide. Advances in molecular diagnostics and targeted therapies have transformed treatment paradigms, yet the integration of molecular testing into routine care for resected NSCLC specimens continues to face significant challenges. This review outlines the technical, clinical, and systemic barriers that limit the effectiveness of molecular testing. Key considerations include tissue quality, the limitations of formalin-fixed paraffin-embedded (FFPE) samples, and the comparative roles of conventional methods—such as immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and reverse transcription polymerase chain reaction (RT-PCR)—versus next-generation sequencing (NGS). We also discuss the prevalence and clinical relevance of common genomic alterations, including TP53, KRAS, EGFR, and ALK, as well as their impact on prognosis and treatment selection. Real-world obstacles such as accessibility, reimbursement, delays in testing, interdisciplinary coordination, and sample adequacy are critically examined. Emerging innovations—including multi-omics integration, spatial profiling, liquid biopsy, artificial intelligence, and novel targeted therapies—offer opportunities to overcome current limitations and improve patient outcomes. Finally, practical recommendations are proposed to optimize tissue handling, testing algorithms, and access to precision-guided therapies. By addressing these challenges, molecular testing in NSCLC can be more effectively leveraged to personalize treatment strategies and enhance survival outcomes. Full article

Objective: This study investigates the prognostic value and clinical utility of the neutrophil percentage-to-albumin ratio (NPAR) in patients with resected non-small-cell lung cancer (NSCLC). Methods: We retrospectively included 335 patients with NSCLC who underwent lung resection at our institution between January 2017 and October 2018. Optimal cutoffs for preoperative and postoperative day 1 (D1) NPAR were determined using X-tile (version 3.6.1; Yale University, New Haven, CT, USA) to define high and low groups. Overall survival (OS) was evaluated using Kaplan–Meier analysis and Cox proportional hazards models. A perioperative NPAR trajectory (low–low, low–high, high–low, high–high) was constructed to characterize dynamic risk patterns. To mitigate potential bias associated with postoperative measurements, a D1 landmark analysis was performed. A nomogram was developed based on the multivariable model and assessed by calibration at 1, 3, and 5 years. Incremental clinical value beyond TNM stage and surgical approach was evaluated using decision curve analysis (DCA), as well as by 5-year continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: The optimal cutoffs for preoperative and postoperative D1 NPAR were 14.5 and 23.1, respectively. In univariate analyses, sex, smoking history, preoperative NPAR, postoperative D1 NPAR, pathologic type, TNM stage, surgical approach, and adjuvant therapy were associated with OS (all p < 0.01). In multivariable Cox regression, high preoperative NPAR (HR 1.896, 95% CI 1.135–3.168; p = 0.014) and high postoperative D1 NPAR (HR 1.905, 95% CI 1.097–3.305; p = 0.014) were independent risk factors, along with TNM stage (Stage II: HR 2.824, 95% CI 1.209–6.595; p = 0.016; Stage III: HR 9.470, 95% CI 4.935–18.171; p < 0.001) and open surgery (HR 2.350, 95% CI 1.341–4.117; p = 0.003). Trajectory analysis further stratified risk, with the high–high group showing the poorest survival (adjusted HR 3.48, 95% CI 1.43–8.47; p = 0.006). The association of postoperative NPAR persisted in the D1 landmark analysis (HR 1.836, 95% CI 1.071–3.148; p = 0.027). Adding NPAR to TNM stage and surgical approach improved 5-year risk reclassification (continuous NRI 0.377, 95% CI 0.094–0.659; IDI 0.028, 95% CI −0.002–0.054) and increased net benefit on DCA. The nomogram demonstrated acceptable calibration at 1, 3, and 5 years. Conclusions: This study demonstrates that NPAR serves as an independent prognostic marker for long-term outcomes in patients with NSCLC. The use of NPAR offers clinicians a comprehensive and precise tool for assessing patient prognosis. Full article

¹⁸F-fluorodeoxyglucose (FDG) PET/CT is widely used for the evaluation of pulmonary lesions but lacks specificity, as increased FDG uptake is frequently observed in inflammatory and reparative processes. This limitation may lead to false-positive interpretations and unnecessary surgical resections. This study aimed to evaluate the immunohistochemical expression of integrin α_vβ₆ in 18 surgically resected pulmonary lesions that were falsely classified as malignant on FDG PET/CT, in order to find out if ⁶⁸Ga-Trivehexin PET/CT could have superior preoperative diagnostic specificity. Histopathological examination classified all lesions as non-neoplastic inflammatory processes of varying etiologies. Integrin α_vβ₆ expression was detected in all immunohistochemically examined tissue specimens (18/18 cases (100%)), with moderate membranous overexpression in 2/18 cases (11.11%) and strong membranous overexpression in 16/18 cases (88.89%) observed in the alveolar and bronchial epithelium of inflammatory lung lesions. Our findings indicate that integrin α_vβ₆ is upregulated not only in neoplastic lung tissue but also in inflammatory lesions, suggesting that integrin α_vβ₆ may have limited specificity for distinguishing primary neoplastic from inflammatory pulmonary lesions when used alone. Its interpretation requires integration with other clinical imaging modalities and histopathological data. Full article

Purpose: Surgical resection of liver or pulmonary oligometastases (LP-OMD) in colorectal cancer (CRC) has been shown to improve survival. Stereotactic body radiotherapy (SBRT) is a promising alternative for patients with primary lung cancer. However, the efficacy of SBRT for LP-OMD in CRC remains inconclusive, and local control (LC) rates are often unsatisfactory. This prospective study aimed to evaluate the treatment outcomes of dose-escalated and convergent SBRT for patients with LP-OMD from CRC, with the goal of demonstrating its effectiveness as a treatment option for these patients. Methods and materials: This study included 23 CRC patients with LP-OMD who received SBRT between 2017 and 2022. The inclusion criteria were histologically confirmed colorectal adenocarcinoma, one to three oligometastases, and a tumor diameter of 5 cm or less. Patients who were inoperable or declined surgery were included. SBRT was delivered with total doses of 50–60 Gy administered over five fractions, covering the planning target volume surface within the 60% isodose line of the maximum dose. The primary endpoint was the 2-year LC rate, while secondary endpoints included overall survival (OS), progression-free survival (PFS), and toxicity. Results: The median follow-up duration was 41.0 months (range: 11.5–77.2). At the time of analysis, five patients had died from CRC, six were alive with disease, and twelve were alive without disease. Only one patient experienced local recurrence of a pulmonary oligometastasis. The 2-year LC, PFS, and OS rates were 95.0% (95% CI: 69.5–99.3), 61.3% (95% CI: 40.0–77.0), and 88.1% (95% CI: 67.6–96.0), respectively. Toxicity was acceptable, with no grade ≥ 3 adverse events. Conclusions: High-central-dose SBRT for LP-OMD from CRC achieved favorable local control with minimal toxicity. These findings should be interpreted cautiously and require validation in larger, multi-institutional studies. Full article

Background/Objectives: Accurate assessment of pulmonary function is essential before planning radical lung cancer treatment. While spirometry reflects global lung function, perfusion imaging provides detailed information on regional perfusion patterns. This study aimed to characterize the pre-treatment profile of patients and compare the impact of surgical resection, radiotherapy, and thermal ablation on global pulmonary function and regional perfusion using SPECT/CT. Methods: In this prospective study of 68 patients, pre- and post-treatment assessments were conducted using lung perfusion SPECT/CT. While the entire cohort underwent imaging, longitudinal global pulmonary function (spirometry and gas diffusion) was analyzed for 45 patients who completed the three-month follow-up. Quantitative analysis included perfusion percentages and lung volumes, while a semi-quantitative scoring system evaluated the severity of perfusion defects. Results: In the overall cohort, the affected lung perfusion and volume significantly decreased (p = 0.002). Subgroup analysis revealed that the surgical resection group experienced significant reductions in perfusion (from 54.0% to 41.0%, p = 0.002) and volume (p < 0.001) of the affected lung, whereas no statistically significant changes were observed in the thermal ablation and radiotherapy groups (p > 0.05). Notably, 60.3% of patients presented with perfusion defects before treatment. Post-treatment spirometry parameters, particularly FEV1% (threshold 83.5%, AUC = 0.783), served as reliable predictors of persistent perfusion impairment. Conclusions: Radiotherapy and thermal ablation are lung-perfusion-sparing treatments compared to surgical resection. The high prevalence of pre-existing perfusion defects emphasizes the importance of incorporating lung perfusion SPECT/CT into routine pre-treatment evaluation to optimize treatment selection. Full article

Background/Objectives: Intrapulmonary metastasis (IPM) after an initial single primary lung cancer (SPLC) is an adverse follow-up pattern; however, when studying population-based longitudinal records, the determinants remain unclear. We aimed to identify factors associated with subsequent IPM after initial SPLC using artificial intelligence (AI)-driven analytical approaches. Methods: We used Surveillance, Epidemiology, and End Results (SEER) lung cancer records from 2000 to 2019. Adults with at least two records were restricted to those with SPLC at the first record. Outcome at the second record was registry-classified IPM versus persistent SPLC. A machine learning framework based on random forest models was developed using baseline variables, first record characteristics, and the interval between records. Temporal validation was performed by training on cases from 2000 to 2013 and testing on cases from 2014 to 2019. A dynamic Bayesian network (DBN) supported simulated intervention (SI) analyses to estimate model-implied risk ratios (RRs) with 95% confidence intervals (CIs). Results: Among 3450 patients, 361 had registry-classified IPM at the second record. The random forest model achieved an area under the curve (AUC) of 0.852 in internal validation and 0.929 in temporal validation. Surgery and record timing were the leading predictors. The DBN retained surgery as the only direct parent and achieved an AUC of 0.779. SI analyses showed higher IPM probability for pleural invasion level (PL) 3 versus PL 0, RR 1.378 (95% CI, 1.080–1.657). Lobectomy with mediastinal lymph node dissection versus wedge resection lowered the IPM probability, RR 0.378 (95% CI, 0.219–0.636). Conclusions: AI-based time-sequence modeling integrating machine learning and a DBN allowed for the identification of surgery, pleural invasion, and record timing as key factors associated with subsequent IPM classification after initial SPLC. This framework demonstrates the potential of combining predictive and probabilistic dependency modeling to investigate registry-based disease classification patterns, and may support hypothesis generation for future prospective studies. Full article

Introduction: Lung cancer remains the leading cause of cancer-related mortality among men in Poland. Prognosis is generally poor, largely due to late diagnosis at advanced stages and the aggressive biological nature of the disease. Aim: This study aimed to evaluate the effectiveness of various treatment modalities and determine their impact on overall survival in male patients diagnosed with small-cell (SCLC) and non-small-cell lung cancer (NSCLC). Methods: This retrospective cohort study analyzed 1431 men (mean age: 61.5 years) treated at the Katowice Oncology Center in Poland between 2002 and 2012. Overall survival was assessed using the Kaplan–Meier method and multivariable Cox proportional hazards regression. Evaluated prognostic factors included clinical stage, surgical intervention (partial or total lung resection), first-line treatment regimen, and the number of treatment cycles. Results: Survival probabilities declined progressively with advancing clinical stage for both SCLC and NSCLC. Patients who underwent surgical resection demonstrated significantly longer survival compared to non-surgically treated patients (p < 0.001). Furthermore, combined radiochemotherapy yielded superior therapeutic outcomes compared to chemotherapy alone. In the non-surgical NSCLC cohort, first-line treatment with platinum derivatives combined with gemcitabine resulted in the highest 1-year survival rate compared to other pharmacological schemes. Discussion: The high mortality observed within the first 12 months post diagnosis reflects the late-stage presentation common during the study period. The findings align with established oncological principles, confirming that surgical resection and multimodal therapies offer the greatest survival advantages for eligible patients. Conclusions: Survival rates for both SCLC and NSCLC are overwhelmingly dictated by early diagnosis and the feasibility of surgical resection. Improving long-term outcomes depends heavily on implementing effective lung cancer screening programs to detect the disease at operable stages and utilizing optimized combined treatment protocols. Full article

Introduction: Lymph node status is a key prognostic factor of lung cancer. Although video-assisted thoracoscopic surgery (VATS) is widely used for early-stage disease, its consistency in achieving thorough lymph node dissection remains debated. While many studies show outcomes comparable to thoracotomy, others question its reliability for accurate staging in advanced cases. This study compared the oncologic efficacy of VATS and thoracotomy in pulmonary adenocarcinoma, focusing on lymph node dissection and postoperative outcomes. Materials and Methods: A retrospective analysis was conducted on 111 consecutive patients who underwent curative-intent resection for pulmonary adenocarcinoma between 2019 and 2023 at the “Prof. Dr. Alexandru Trestioreanu” Oncological Institute, 52 undergoing thoracotomy and 59 Video-Assisted Thoracoscopic Surgery (VATS). Results: Demographic and clinical characteristics were comparable between groups. Compared with thoracotomy, VATS was associated with a significantly higher number of harvested lymph nodes at stations 7 and 10. No significant differences between groups in the number of positive lymph nodes, postoperative morbidity, or 30-day mortality were observed. Conclusions: VATS appears to provide comparable lymph node retrieval and short-term outcomes to open surgery. These findings add valuable data from an underrepresented Eastern European population and support the broader adoption of minimally invasive techniques in lung cancer surgery. Full article

Background: This study employed artificial intelligence (AI) to analyze quantitative nuclear morphological features obtained from digital pathology images to predict postoperative recurrence in patients with lung squamous cell carcinoma (LSQCC). We aimed to develop a prediction model that contributes to the realization of ‘personalized postoperative management’ tailored to individual tumor biology by integrating AI-extracted morphological features with clinical information. Methods: A total of 185 of the 253 surgically resected LSQCC cases were included; 136 were randomly assigned to the training set and 49 to the test set. Nuclear features from manually selected regions of interest were extracted and used to build AI-based prediction models. Three recurrence models were developed: recurrence within 2 years, within 5 years, and a three-category model (≤2 years, 3–5 years, >5 years or no recurrence). Support vector machine (SVM) and random forest (RF) algorithms were applied to each, yielding six predictive models. An ensemble approach was used to calculate AI-based risk scores, and a “total risk score” was developed by integrating these with the pathologic stage. Results: All six AI models demonstrated stable predictive performance, with AUC values ranging from 0.76 to 0.91. Kaplan–Meier analysis showed that the total risk score provided the most precise risk stratification (p < 0.005), with clearer separation between risk groups than the AI-based risk score alone. Conclusions: The integration of AI-based nuclear morphology analysis and clinical data provides an objective and practical tool for personalized postoperative management in LSQCC. This approach enables tailored clinical decision-making by identifying patients at high risk for early recurrence and customizing postoperative treatment plans to meet the specific needs of each individual. Full article

Background: Surgery represents the gold standard treatment for patients with stage I non-small cell lung cancer (NSCLC); however, up to 30% of those may experience recurrence. This study aims to identify prognostic factors for both early and late recurrence in this subset. Methods: We retrospectively analyzed the data of patients with stage IA-B NSCLC undergoing lung resection from 2013 to 2021 in four major lung cancer centers. Inclusion criteria were intentionally curative resections via either open or mini-invasive approaches plus lymph node dissection and a minimum follow-up of 36 months. Analyzed prognosticators included age, gender, smoking status, comorbidities, radiological appearance, surgical approach, intraoperative complications, pT stage and histologic subtypes. The overall and disease-free survivals and uni- and multivariable Cox regression for recurrence prediction were analyzed. Results: We collected data from 1132 consecutive patients (mean age 68.5 ± 8.8 years, 55.5% males and 20.1% smokers). After a mean follow-up of 57 ± 37 months, 908 (80.2%), patients were still disease-free, while the remaining 224 (19.8%) presented local (n = 86) or distant (n = 138) recurrences; 72 (32.1%) patients experienced reoccurrence within 12 months. The disease-free survival rate was significantly higher in the pT1a stage and in lepidic adenocarcinoma. The multivariable analysis and Cox regression showed that pT>1a (p = 0.001) and non-lepidic subtypes of adenocarcinoma (p < 0.001) were the best predictors of recurrence. Conclusions: Approximately one fifth of patients undergoing radical surgery for stage I NSCLC experienced recurrence within five years. Significant predictors of recurrence were a pT status greater than 1a and non-lepidic subtypes of adenocarcinoma. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) coexists with lung cancer in 40–70% of cases and increases perioperative risk, particularly in patients with severely impaired pulmonary function. Preoperative pulmonary rehabilitation (PR) has been proposed as a perioperative optimization strategy; however, its effect on hospital length of stay (LOS) in patients with advanced COPD remains unclear. This study aimed to compare postoperative complications, intensive care unit (ICU) utilization, and hospital LOS between patients with lower and higher baseline forced expiratory volume in one second (FEV1), and to evaluate the role of preoperative PR as a risk-adaptive perioperative strategy in high-risk COPD patients undergoing lung cancer surgery. Methods: This retrospective cohort study comprises patients with spirometry-confirmed COPD and non-small cell lung cancer (NSCLC) who underwent elective lung resection at a tertiary care center between March 2019 and June 2020. Disease severity was classified using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) framework: GOLD 1–2 (FEV1 ≥ 50% predicted) and GOLD 3–4 (FEV1 < 50% predicted). Patients in the GOLD 3–4 group received a uniform 15-day hospital-based preoperative PR program prior to surgery. Primary outcomes were ICU stay, postoperative complications, and hospital LOS. Factors independently associated with prolonged hospital stay were examined using an exploratory multivariable linear regression model. Results: Among 63 patients (95.2% male; median age 64 years), those with GOLD 3–4 COPD had significantly lower baseline FEV1 values and longer COPD duration compared with the GOLD 1–2 group. Despite a higher perioperative risk profile, postoperative complication rates (28.6% overall; p = 0.237) and ICU utilization were comparable between groups. Median postoperative hospital LOS was significantly longer in patients with GOLD 3–4 COPD (15 [IQR 6] vs. 11 [IQR 4] days; p < 0.001). In the exploratory regression analysis, lower predicted FEV1 percent (p = 0.003) and older age were independently associated with prolonged hospital stay, whereas PR was not an independent determinant of LOS. Conclusions: In patients with lung cancer and severe COPD (GOLD 3–4) who received preoperative PR, postoperative complication rates and ICU utilization were comparable to those observed in patients with less severe disease. Prolonged hospital stay in the high-risk group was independently associated with lower FEV1 and older age, reflecting underlying disease severity. Prospective controlled studies stratified by COPD severity are needed to establish the independent contribution of preoperative PR in this population. Full article

Introduction and Importance: Colorectal adenocarcinoma typically metastasizes to the liver and lungs, with pleural, breast, or osseous involvement being exceedingly rare. Here, we report an unusual case of rectal adenocarcinoma metastasizing to the chest wall with simultaneous involvement of the lung, pleura, ribs, and subcutaneous breast tissue, forming a dominant giant metastasis (25 × 18 × 16 cm) accompanied by additional satellite lesions between the ribs and pectoral muscles, as well as intrapulmonary nodules. Presentation of case: The patient underwent radical resection including rib excision, followed by hyperthermic intrathoracic chemotherapy (HITHOC) with mitomycin. Chest wall integrity was restored using a synthetic mesh and titanium plating, ensuring both oncologic clearance and structural stability. Multimodal therapy also included neoadjuvant chemotherapy with bevacizumab, which was continued postoperatively. Clinical discussion: This case underscores the critical role of a multidisciplinary strategy in managing rare and aggressive metastatic patterns of colorectal cancer. In selected patients, a combination of systemic therapy, extensive surgical resection, advanced reconstruction, and regional chemotherapy may offer the potential for short-term local disease control. Conclusions: The radical excision of the giant tumour enabled continuation of systemic therapy under the national drug programme, was associated with short-term local control, and improved the patient’s quality of life. Full article

Background: Current guidelines recommend lobectomy for tumors > 20 mm on CT, yet systematic CT–pathology size discordance may contribute to size-threshold–driven surgical decisions. We hypothesized that CT-based tumor diameter differs from pathological size near the 20 mm surgical boundary, potentially leading a proportion of patients to undergo more extensive resection than pathology would indicate under a size-only rule. Methods: We retrospectively analyzed 1096 patients undergoing thoracoscopic surgery for clinical stage I non-small cell lung cancer at a single center (2020–2024). CT–pathology agreement was assessed via Bland–Altman analysis. Optimal CT cut-off was identified using restricted cubic spline (RCS) modeling, internally validated with bootstrap resampling (B = 2000), and evaluated by decision curve analysis (DCA). Results: CT showed size-dependent bias: overestimation in small tumors (T1a: +4.21 mm) transitioning to underestimation in larger lesions (≥T2: −7.49 mm). At the 20 mm threshold, 15.8% of patients (n = 173) underwent lobectomy despite pathological size ≤ 20 mm (potential overtreatment). RCS modeling and bootstrap-optimized DCA identified 23 mm as the candidate revised threshold. Adopting CT > 23 mm would reclassify 108 patients from lobectomy to sublobar resection, reducing size-threshold–defined potential overtreatment by 51.4% while maintaining sensitivity for true ≥ T2 tumors. Conclusions: CT demonstrates size-dependent discordance with pathological size; this discordance likely reflects both CT measurement inaccuracy and specimen shrinkage after fixation, and the relative contributions cannot be separated from these data. A candidate 23 mm CT threshold, supported by DCA and internal bootstrap validation, could reduce size-threshold–defined potential overtreatment by 51% in this cohort. Prospective multicenter validation is required before clinical implementation. Full article

Background: Robotic-assisted thoracic surgery is increasingly recognized as an advanced minimally invasive technique for treating non-small cell lung cancer, offering technical advantages such as enhanced precision and visualization. Although numerous studies have been published worldwide, there are no comparable data from Poland. Therefore, evidence on the perioperative safety and oncologic adequacy of robotic-assisted lobectomy during early phase of program implementation within the Polish healthcare system remains limited. Methods: This retrospective, single-institution observational study included 81 consecutive patients who underwent robotic-assisted lobectomy for primary NSCLC between January 2022 and December 2024. All procedures were carried out using the da Vinci Xi system with a standardized four-arm portal approach. Clinical, perioperative, and pathologic parameters were prospectively collected and analyzed descriptively. Postoperative complications were classified according to Clavien-Dindo. Results: The median patient age was 70 years (IQR: 65–74), 52% were male, and 67% had a history of smoking. Adenocarcinoma was the predominant histologic subtype (51%). The median operative time was 176 min (IQR: 149–220). There were no conversions to thoracotomy and no 30-day mortalities. Postoperative complications occurred in 24% of cases, with prolonged air leak being most common (17%). The median hospital stay was 8 days (IQR: 6–10). R0 resection was achieved in 96% of patients, with a median of 14 lymph nodes dissected across 5 nodal stations. Conclusions: Robotic-assisted lobectomy performed during the early implementation phase of a national program demonstrated low morbidity, high rates of complete (R0) resection, and adequate lymph node yields consistent with international benchmarks. These results support the feasibility of robotic lobectomy within the Polish healthcare setting; however, the single-surgeon, single-center design limits generalizability. Further multicenter prospective studies are needed to confirm reproducibility, assess learning curves, and evaluate long-term oncologic outcomes. Full article

Background: Segmentectomy is increasingly used and is emerging as a key treatment option for early-stage non-small cell lung cancer (NSCLC). However, questions remain regarding the adequacy of lymph node evaluation, particularly differences in N1 versus N2 dissection, and the implications for staging accuracy and adjuvant therapy. Methods: This narrative review synthesizes evidence from studies published between 2019 and 2025 comparing nodal upstaging, survival outcomes, and the role of completion lobectomy following segmentectomy versus lobectomy. Results: Twelve studies, including more than 175,000 patients, were analyzed. Lobectomy was associated with a significantly higher overall nodal upstaging rate (14.5% vs. 6.6%, p < 0.001), driven primarily by increased detection of N1 disease (13.3% vs. 3.7%, p < 0.001), while N2 upstaging rates were similar between procedures (5.5% vs. 3.2%, p = 0.07). Despite lower N1 detection, adjusted analyses reported comparable survival outcomes among patients with occult pathologic N1 (pN1) or N2 (pN2) disease who received adjuvant therapy. Segmentectomy provided outcomes comparable to lobectomy, whereas wedge resection was associated with inferior survival (HR 1.23, p = 0.042). Completion lobectomy has not demonstrated a consistent survival benefit and was associated with substantial morbidity in limited retrospective series, including high rates of thoracotomy conversion and major complications. Conclusions: When performed with systematic nodal dissection, adequate surgical margins, and appropriate adjuvant therapy, segmentectomy appears to provide survival outcomes comparable to lobectomy in selected patients with early-stage NSCLC. Completion lobectomy may not be routinely required and should be considered on a case-by-case basis within a multidisciplinary context. These findings support the use of segmentectomy in carefully selected patients when high-quality surgical staging and integrated oncologic care are ensured, while highlighting the need for prospective studies addressing occult nodal disease in the modern treatment era. Full article