Redefining the concept of resectability in the landscape of perioperative treatments for lung cancer

作者：Petrella F, Cara A, Cassina EM, Dell'Agosto J, Libretti L, Pirondini E, Raveglia F, Tuoro A · 发表于：Frontiers in oncology · 年份：2026 · DOI：10.3389/fonc.2026.1903430 · 被引用次数：20 · 研究领域：lung resection、non-small cell lung cancer (NSCLC)、perioperative treatments、radiotherapy、resectability、surgery

Resectability in non-small cell lung cancer (NSCLC) is shifting from a purely anatomic and surgical concept, based on technical feasibility of an R0 resection, to an integrated, multidisciplinary determination that incorporates tumor biology, expected benefit from perioperative systemic therapy and operative risk. Contemporary guidelines emphasize that resectability-particularly in stage III disease-should be defined by an experienced multidisciplinary team (MDT) with thoracic surgical input, alongside standardized staging and biomarker assessment to guide systemic options. Perioperative immune checkpoint inhibitor (ICI) plus chemotherapy regimens have expanded the population considered for curative-intent surgery by improving pathologic response and event-free survival, while also introducing new determinants of resectability, such as likelihood of completing multimodality therapy and managing treatment-related toxicity. Resectability in locally advanced (stage III) NSCLC is a multidisciplinary determination that complete oncologic resection is achievable with acceptable operative risk, and that surgery adds value within a multimodality plan rather than being based on anatomy alone. Key elements of resectable stage III NSCLC are: R0 resection goal with guideline-concordant nodal dissection; nodal extent drives resectability more than T stage as N3 is generally unresectable while single-station, non-bulky N2 is most commonly considered potentially resectable, whereas bulky an...