J.Jpn. Surg. Soc.. 125(4): 348-357, 2024

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Feature topic

SURGERY FOLLOWING NONSURGICAL TREATMENT FOR LOCALLY ADVANCED LUNG CANCER

The treatment strategy for locally advanced lung cancer should be individually considered after careful evaluation of the characteristics of each patient including tumor extent such as invasion of adjacent organs and mediastinal nodal involvement. For patients with resectable disease, surgery may be performed as an initial treatment or after induction treatment such as chemotherapy and chemoradiotherapy. Recently, several randomized clinical trials have shown that induction chemotherapy plus immunotherapy (chemoimmunotherapy) provided superior clinical outcomes, which has been established as a standard of care for locally advanced non-small cell lung cancer. For patients with locally advanced non-small cell lung cancer that is initially diagnosed as unresectable disease, nonsurgical treatment such as chemoradiotherapy followed by maintenance immunotherapy using durvalumab may be prescribed. After initial nonsurgical treatment, some patients may be diagnosed as having resectable disease for several reasons including conversion to resectability due to tumor shrinkage. On such occasions, salvage surgery might provide a favorable prognosis in selected patients. Accordingly, an increasing number of patients may receive surgery after nonsurgical treatment not only for resectable disease but also for initially unresectable disease. In this article, we review the current evidence on surgical treatment following nonsurgical treatment.

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