Preface to lung cancer surgery

Lung cancer is the primary cause of cancer-related death and the second commonest cancer worldwide, with an estimated 2.2 million new cases and 1.8 million deaths worldwide reported during 2020. The large healthcare burden has driven research in prevention, early detection with screening, and developments in treatment leading to remarkable improvements in outcomes. Patients with early-stage non-small cell lung cancer (NSCLC) can typically be offered curative surgical resection whereas small cell lung cancer (SCLC) is often managed non-surgically. Patients with stage I NSCLC have a reported 5-year survival of approximately 80%, with stage II–III having a survival rate ranging between 13–60% in the surgical resection cohort. Although associated with substantial toxicities, the addition of adjuvant chemotherapy with stage II, IIIA, and selected stage IB disease can improve survival by a further 5–10%. Therefore, the effective surgical management of lung cancer is strongly underpinned by accurate diagnosis, screening, and staging; with benefits pronounced in early-stage disease. Furthermore, the integration of targeted therapies and immune checkpoint inhibitors (ICIs) into the surgical pathway is the focus of much of the ongoing work in the field.

In this special series, we are covering important topics related to lung cancer and the current state of screening, staging, and perioperative optimization in lung cancer surgery. Different surgical options are then explored, including recent advancements with minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), which improves short-term outcomes and minimizes pain, with comparable oncological outcomes to the traditional thoracotomy. As well as comments on the ongoing discussion on the efficacy of lobectomy versus sub-lobar resection for early-stage lung cancer. We will round off the series with a discourse on what role immunotherapy and targeted therapies can have in a multi-modality surgical pathway.

We would like to thank all the authors that have participated in this series. For the time they devoted to writing the articles and to share their knowledge and expertise with us. We also would like to thank the VATS editorial team in facilitating this special series and processing the manuscripts in a timely manner.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Video-Assisted Thoracic Surgery for the series “Lung Cancer Surgery”. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://vats.amegroups.com/article/view/10.21037/vats-23-35/coif). The series “Lung Cancer Surgery” was commissioned by the editorial office without any funding or sponsorship. Both authors served as the unpaid Guest Editors of the series. AH serves as an unpaid editorial board member of Video-Assisted Thoracic Surgery from August 2019 to July 2025. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Michael Shackcloth

Amer Harky