State of the art and new perspectives in surgical treatment of lung cancer: a narrative review
Review Article

State of the art and new perspectives in surgical treatment of lung cancer: a narrative review

Francesco Petrella1,2, Stefania Rizzo3,4, Monica Casiraghi1,2, Claudia Bardoni1, Shehab Mohamed1, Valeria Musso1, Emanuele Simonini1, Lorenzo Spaggiari1,2

1Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy; 2Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; 3Service of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Lugano, Switzerland; 4Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland

Contributions: (I) Conception and design: F Petrella, S Rizzo; (II) Administrative support: F Petrella, S Rizzo, M Casiraghi, S Mohamed, C Bardoni, V Musso, E Simonini; (III) Provision of study materials or patients: F Petrella, S Rizzo, M Casiraghi, S Mohamed, C Bardoni, V Musso, E Simonini; (IV) Collection and assembly of data: F Petrella, S Rizzo, M Casiraghi, S Mohamed, C Bardoni, V Musso, E Simonini; (V) Data analysis and interpretation: F Petrella, S Rizzo; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Francesco Petrella, MD, PhD. Department of Thoracic Surgery, IRCCS European Institute of Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Via Ripamonti, 435 - 20141 Milan, Italy. Email:;

Background and Objective: Lung cancer is the leading cause of cancer-related deaths worldwide, and its incidence has increased over the past two decades. The standard care for stage I, stage II, and selected cases of stage IIIA non-small cell lung cancer (NSCLC) is surgical resection; in some cases, patients may be offered adjuvant systemic therapy after surgical resection. Patients with lung cancer presenting with distant metastases belong to stage IV: in this setting, some carefully selected patients may benefit from surgery within a multimodality approach.

Methods: We performed a comprehensive, non-systematic review of the latest literature to define the present role of surgery in lung cancer treatment.

Key Content and Findings: The literature review disclosed a pivotal role of surgery in early stage lung cancer and a complimentary role in locally advanced lung cancer; in very selected cases, surgery might be considered in oligometastatic disease.

Conclusions: Surgical treatment of lung cancer still plays a pivotal role in early stages of the disease while, in locally advanced stages, it may contribute to improve overall survival in combination with medical treatments and radiotherapy. More recently, an effective role of surgery has been advocated in carefully selected oligometastatic patients with encouraging initial results.

Keywords: Lung cancer; early stage; locally advanced; metastatic stage; surgery

Submitted May 27, 2022. Accepted for publication Aug 25, 2022.

doi: 10.21037/tcr-22-1491



To focus on the present role of surgical treatment of early stage, locally advanced and oligometastatic lung cancer patients.


Lung cancer is one of the most frequently diagnosed cancers and is the leading cause of cancer-related death worldwide (1). It accounts for more than 1.8 million newly diagnosed cancer cases—representing 13% of the total diagnosed cancer cases—and 1.6 million cancer-related deaths (19.4% of the total) in the world every year (2). Although the incidence of lung cancer is decreasing in developed countries, it is rising in less developed parts of the world (South America, Africa, China and Eastern Europe) probably due to less rigorous smoking regulations (2). Smoking cessation, in fact, is crucial for preventing lung cancer, and public health actions aimed at quitting smoking have effectively helped to reduce the incidence of lung cancer (3-5). In addition, after receiving a lung cancer diagnosis, smoking cessation is significantly related to better overall survival, decreased post-operative complications, enhanced response to systemic therapies, better response to radiation therapy and—above all—significantly improved quality of life (6). Clinical outcomes in lung cancer are strictly related to the cancer stage at the time of diagnosis, ranging from good results in early stages to extremely poor outcomes in advanced disease (7).

The standard care for stage I, stage II, and selected cases of stage IIIA non-small cell lung cancer (NSCLC) is surgical resection; in some cases, patients may be offered adjuvant systemic therapy after surgical resection (8,9). Stage III NSCLC is a heterogeneous disease and therapeutic options vary depending on tumor burden, symptoms as well as several patient factors. Surgical approach to stage III NSCLC is still widely debated (8).

Patients with lung cancer presenting with distant metastases belong to stage IV; in this setting, the goals are to improve quality of life and to prolong overall survival; the best options for cure in this stage are chemotherapy, targeted therapy and immunotherapy (8). We present the following article in accordance with the Narrative Review reporting checklist (available at


Research selection

English literature review from 1995 to 2022 from PubMed and Scopus was performed (Table 1).

Table 1

The search strategy summary

Items Specification
Date of search 25 May 2022
Databases and other sources searched PubMed/Medline, Scopus and guidelines of relevant thoracic/oncologic societies
Search terms used ((lung cancer))) AND ((surgery) OR (surgical) OR (procedure) OR (resection)) AND ((early) OR (advanced) OR (oligometastatic) OR (metastatic))
Timeframe 1995–2022
Inclusion and exclusion criteria Inclusion criteria: Original Articles, Review Articles
Exclusion criteria: non-English language; Case Reports; Letters to the Editor
Selection process FP and SR independently conducted the search; all the authors contributed to final version of the paper


Early stage

Surgical resection is the gold standard of treatment for early-stage lung cancer and lobectomy with lymphadenectomy represents the standard surgical approach since 1960 (9). In 1995, a first randomized controlled trial compared sublobar resection with standard lobectomy in stage IA lung cancer patients in terms of overall survival with detrimental results. Patients submitted to sublobar resection, in fact, disclosed a higher death rate and a three-fold risk for local relapses (10); since then, sub-anatomical resections for early-stage lung cancer have therefore only been taken into consideration for very selected patients with poor cardiopulmonary function or other significant comorbidities contraindicating lobectomy.

More recently, thanks to computed tomography (CT) screening of lung cancer and advances in diagnostic modalities, such as thin-section CT, the detection rate of early stage tumors as well as ground glass opacities has significantly increased. As a result, the practical indication of sublobar resections has been more frequently considered as a valuable alternative to standard lobectomy for treating early-stage lung cancer even in fit patients (11).

In a recent multicenter, open-label, phase III, randomized, controlled, non-inferiority trial form the West Japan Oncology Group and Japan Clinical Oncology Group, segmentectomy was compared to lobectomy in small-sized peripheral NSCLC. At a median follow-up of 7.3 years, the 5-year overall survival was 94.3% for segmentectomy and 91.1% for lobectomy, thus showing improved overall survival across all predefined subgroups in the segmentectomy group. Moreover, the 5-year relapse-free survival was 88% for segmentectomy and 87.9% for lobectomy (P=0.9889) and the proportions of patients with local relapse were 10.5% for segmentectomy and 5.4% for lobectomy (P=0.0018), in both cases without any significant difference (12). This study was the first trial showing the advantages of segmentectomy compared to lobectomy—in terms of overall survival—in patients with small-peripheral NSCLC. The results suggested that segmentectomy should be the standard surgical treatment for this cohort of patients, irrespective of cardiopulmonary functions and comorbidities (12). Nevertheless, the present gold-standard treatment for NSCLC remains standard lobectomy with lymphadenectomy.

Jang et al. recently analyzed the trend—during the last two decades—of stereotactic body radiation therapy (SBRT) as an alternative to surgery for treating early-stage NSCLC (13). They showed that, although lobectomy remains the most frequent and preferred therapeutic approach, there was a significant increase in the rate of SBRT from 2004 to 2016, with a corresponding decrease in patients receiving no treatment (13). Moreover, they observed that the size of neoplastic lesions decreased across all therapeutic approaches, thus reflecting early detection and consequently less extensive diseases to be treated; in fact, patients who did not receive any local treatments (SBRT or surgery) tended to have the largest neoplastic lesions (13).

As reported before, surgery still represents the standard of care for early-stage NSCLC patients in good clinical conditions; anyway, for those who are in poor conditions or unwilling to receive surgery, SBRT represents the best alternative therapeutic option (14). However, radiotherapy may generate toxicity which depends on several factors, such as the whole amount of healthy tissue irradiated and natural variation of radiosensitivity of the healthy tissues (15). Side effects of radiation therapy can be acute or late: in the first case, they occur within the first 90 days after treatment and usually resolve totally although in some cases they may significantly affect quality of life and occasionally may even cause death (16). Moreover, when radiotherapy-related acute side effects are not properly resolved, they may culminate in a clinical scenario defined as “consequential late damage” (17). On the other hand, late adverse events are more frequently impossible to reverse, being progressive and thus impacting more significantly than acute adverse events on the patient’s quality of life (17).

Locally advanced stage

About 10–20% of new diagnoses of NSCLC are patients with stage IIIA disease, presenting with mediastinal ipsilateral lymph node involvement. In very selected cases, these patients may benefit from surgery but, in the light of the significant heterogeneity of this cohort of patients, a multimodality approach must always be considered. In fact, mediastinal lymph node involvement may range from very limited N2 disease (single station N2 disease) to a multi station or bulky mediastinal involvement (18). This explains the wide variety of therapeutic options in locally advanced disease, the multimodality approach being the best option in this setting. Preoperative chemotherapy—defined as induction treatment—followed by pulmonary resection has shown to favorably impact on progression-free survival and overall survival in potentially resectable N2 patients (19). In fact, radically resected N2 patients after induction treatment disclosed a five-year overall survival of 35% that was significantly higher than that of patients receiving exploratory thoracotomy or incomplete resection, whose five-year overall survival was 8% (19-21) thus emphasizing the therapeutic role of surgery to treat the residual neoplastic disease in selected patients.

In the Intergroup 0139 study, patients treated by lobectomy disclosed a considerable benefit in terms of survival thanks to the addition of surgery to induction chemotherapy and radiation (22); on the other hand, patients undergoing pneumonectomy did not show a similar advantage in terms of survival because of marked perioperative mortality (22). At this stage appropriate patient selection for surgical approach therefore plays a pivotal role and should be carefully balanced by a multidisciplinary approach (23). An update from the PACIFIC trial disclosed a reduced risk of death by 29% thanks to consolidation therapy with one year of durvalumab; moreover, patients receiving consolidation immunotherapy had a four-year overall survival of 49.6% compared to 36.3% observed in patients not receiving immunotherapy (24).

Additional promising data has come from studies focusing on preoperative immunotherapy with durvalumab combined with chemotherapy (induction chemo-immunotherapy) followed by surgical resection in patients with multiple stations or single station lymph node involvement (25) as well as from chemo-radio-immunotherapy (26). Surgical specimens disclosed major pathological response in 62% of treated patients and complete pathological response up to 10% of patients, findings that have been favorably correlated with overall survival and represent the new frontier of multimodality treatments in stage III NSLCC patients (25).

From the surgical point of view, we have to take into consideration that induction treatments increase surgical difficulty and risks because of increased vascular frailty and development of tissues adhesions, thus contributing to higher postoperative morbidity and mortality rate (27,28). Video-assisted thoracoscopic surgery (VATS) resections after induction treatments have thus represented a relative contraindication due to the additional technical difficulties related to the thoracoscopic approach (29-32). Nevertheless, thanks to thoracoscopic techniques and instrument developments, an improved learning curve and a significantly greater experience acquired in recent years, VATS indications have been extended to more challenging procedures (31,32), and some studies suggested that thoracoscopic resection after induction treatments can be safely performed (33-35) although clinical evidence of its safety is still widely debated (35,36).

Oligometastatic stage

Almost half of all lung cancer patients already have stage IV disease at the diagnosis for distant metastases (37-39). They are therefore usually judged not eligible to surgery and approached by medical therapy and palliative procedures if needed. Surgical approach is limited to diagnostic or palliative purposes, curative intent being almost anecdotal. Anyway, stage IV NSCLC patients includes a very heterogeneous population, with significantly different overall survival, depending on the number and sites of metastases.

In 1995, Hellman and Weichselbaum first proposed the “oligometastatic” setting, in which the few metastases observed reflect a specific biology of the primary tumor and a less aggressive attitude compared to standard metastatic disease (40). Some major points should be clearly addressed when dealing with oligo metastatic disease, in particular the number of metastases, their appearance in relation to the primary tumor (metachronous versus synchronous) and the involvement of single or multiple target organs (41,42).

The local treatment of oligometastatic patients has recently become more frequent and clinically relevant, in particular during the last few years thanks to significant improvements in target therapies and immunotherapy, thus overcoming the oncologic approach to contraindicate surgery in this setting (37).

Interestingly, dostarlimab—which is an anti-programmed cell death protein-1 antibody—disclosed encouraging antitumor activity in advanced and relapsing NSCLC that progressed after platinum-based chemotherapy, showing an acceptable safety profile.

Considering the lack of randomized controlled trials focusing on oligometastatic patient treatment, an aggressive approach is recommended for otherwise healthy patients disclosing only one extrathoracic metastatic site, without mediastinal lymph node involvement. In this setting, local control by resection of both primary and metastatic site, or by SBRT is indicated. Patients with a single brain lesion and patients with synchronous metastatic disease rather than metachronous disease disclosed the best overall survival when treated as reported above (43-45).

Casiraghi et al.—in their retrospective analysis of surgically treated synchronous oligometastatic NSCLC—showed an encouraging 30% 5-year overall survival, similar to the previous experience of Ashworth et al. (37,46). Although the majority of treated patients (75%) presented an early recurrence with a median time to recurrence of 9 months, it is worth reporting that 25% of patients did not present any relapse with a median overall survival of 39 months, ranging from 5 to 178 months (37).


Surgical treatment of lung cancer still plays a pivotal role in early stages while, in locally advanced stages, it may contribute to improve overall survival in combination with medical treatments and radiotherapy. More recently, an effective role of surgery has been advocated in carefully selected oligometastatic patients with encouraging initial results.


The authors thank Susan Jane West for editing the English text.

Funding: This work was supported by the Italian Ministry of Health with “Ricerca Corrente”, “5×1000” funds.


Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at The authors have no 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.

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  1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7-33. [Crossref] [PubMed]
  2. Gridelli C, Rossi A, Carbone DP, et al. Non-small-cell lung cancer. Nat Rev Dis Primers 2015;1:15009. [Crossref] [PubMed]
  3. Mithoowani H, Febbraro M. Non-Small-Cell Lung Cancer in 2022: A Review for General Practitioners in Oncology. Curr Oncol 2022;29:1828-39. [Crossref] [PubMed]
  4. Jemal A, Center MM, DeSantis C, et al. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010;19:1893-907. [Crossref] [PubMed]
  5. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311:183-92. [Crossref] [PubMed]
  6. Fares AF, Jiang M, Yang P, et al. Smoking cessation (SC) and lung cancer (LC) outcomes: A survival benefit for recent-quitters? A pooled analysis of 34,649 International Lung Cancer Consortium (ILCCO) patients. J Clin Oncol 2020;38:1512. [Crossref]
  7. Ganti AK, Klein AB, Cotarla I, et al. Update of Incidence, Prevalence, Survival, and Initial Treatment in Patients With Non-Small Cell Lung Cancer in the US. JAMA Oncol 2021;7:1824-32. [Crossref] [PubMed]
  8. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016;11:39-51. [Crossref] [PubMed]
  9. Petrella F, Borri A, Casiraghi M, et al. Operative rigid bronchoscopy: indications, basic techniques and results. Multimed Man Cardiothorac Surg 2014;2014:mmu006. [Crossref] [PubMed]
  10. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 1995;60:615-22; discussion 622-3. [Crossref] [PubMed]
  11. Suzuki K. Whack-a-mole strategy for multifocal ground glass opacities of the lung. J Thorac Dis 2017;9:S201-7. [Crossref] [PubMed]
  12. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 2022;399:1607-17. [Crossref] [PubMed]
  13. Jang JK, Atay SM, Ding L, et al. Patterns of Use of Stereotactic Body Radiation Therapy Compared With Surgery for Definitive Treatment of Primary Early-stage Non-small Cell Lung Cancer. Am J Clin Oncol 2022;45:146-54. [Crossref] [PubMed]
  14. von Reibnitz D, Shaikh F, Wu AJ, et al. Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC). Acta Oncol 2018;57:1567-73. [Crossref] [PubMed]
  15. Scaife JE, Barnett GC, Noble DJ, et al. Exploiting biological and physical determinants of radiotherapy toxicity to individualize treatment. Br J Radiol 2015;88:20150172. [Crossref] [PubMed]
  16. Pijls-Johannesma M, Houben R, Boersma L, et al. High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL. Radiother Oncol 2009;91:443-8. [Crossref] [PubMed]
  17. De Ruysscher D, Niedermann G, Burnet NG, et al. Radiotherapy toxicity. Nat Rev Dis Primers 2019;5:13. [Crossref] [PubMed]
  18. Gillaspie EA, Wigle DA. Management of Stage IIIA (N2) Non-Small Cell Lung Cancer. Thorac Surg Clin 2016;26:271-85. [Crossref] [PubMed]
  19. Spaggiari L, Casiraghi M, Guarize J, et al. Outcome of Patients With pN2 "Potentially Resectable" Nonsmall Cell Lung Cancer Who Underwent Surgery After Induction Chemotherapy. Semin Thorac Cardiovasc Surg 2016;28:593-602. [Crossref] [PubMed]
  20. Spaggiari L, Galetta D, Veronesi G, et al. Superior vena cava replacement for lung cancer using a heterologous (bovine) prosthesis: preliminary results. J Thorac Cardiovasc Surg 2006;131:490-1. [Crossref] [PubMed]
  21. Pelosi G, Petrella F, Sandri MT, et al. A primary pure yolk sac tumor of the lung exhibiting CDX-2 immunoreactivity and increased serum levels of alkaline phosphatase intestinal isoenzyme. Int J Surg Pathol 2006;14:247-51. [Crossref] [PubMed]
  22. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 2009;374:379-86. [Crossref] [PubMed]
  23. Petrella F, Radice D, Guarize J, et al. The Impact of Multidisciplinary Team Meetings on Patient Management in Oncologic Thoracic Surgery: A Single-Center Experience. Cancers (Basel) 2021;13:228. [Crossref] [PubMed]
  24. Faivre-Finn C, Vicente D, Kurata T, et al. Four-Year Survival With Durvalumab After Chemoradiotherapy in Stage III NSCLC-an Update From the PACIFIC Trial. J Thorac Oncol 2021;16:860-7. [Crossref] [PubMed]
  25. Rothschild SI, Zippelius A, Eboulet EI, et al. SAKK 16/14: Durvalumab in Addition to Neoadjuvant Chemotherapy in Patients With Stage IIIA(N2) Non-Small-Cell Lung Cancer-A Multicenter Single-Arm Phase II Trial. J Clin Oncol 2021;39:2872-80. [Crossref] [PubMed]
  26. Käsmann L, Eze C, Taugner J, et al. Chemoradioimmunotherapy of inoperable stage III non-small cell lung cancer: immunological rationale and current clinical trials establishing a novel multimodal strategy. Radiat Oncol 2020;15:167. [Crossref] [PubMed]
  27. Fujita S, Katakami N, Takahashi Y, et al. Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer. Eur J Cardiothorac Surg 2006;29:896-901. [Crossref] [PubMed]
  28. Venuta F, Anile M, Diso D, et al. Operative complications and early mortality after induction therapy for lung cancer. Eur J Cardiothorac Surg 2007;31:714-7. [Crossref] [PubMed]
  29. Hanna JM, Berry MF, D'Amico TA. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis 2013;5:S182-9. [PubMed]
  30. Petrella F. Indications and timing of conversion to thoracotomy during video-assisted lung resection. J Thorac Dis 2018;10:S4159-61. [Crossref] [PubMed]
  31. Gonzalez-Rivas D, Delgado M, Fieira E, et al. Double sleeve uniportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Ann Cardiothorac Surg 2014;3:E2. [PubMed]
  32. Gao HJ, Jiang ZH, Gong L, et al. Video-Assisted Vs Thoracotomy Sleeve Lobectomy for Lung Cancer: A Propensity Matched Analysis. Ann Thorac Surg 2019;108:1072-9. [Crossref] [PubMed]
  33. Huang J, Xu X, Chen H, et al. Feasibility of complete video-assisted thoracoscopic surgery following neoadjuvant therapy for locally advanced non-small cell lung cancer. J Thorac Dis 2013;5:S267-73. [PubMed]
  34. Kamel MK, Nasar A, Stiles BM, et al. Video-Assisted Thoracoscopic Lobectomy Is the Preferred Approach Following Induction Chemotherapy. J Laparoendosc Adv Surg Tech A 2017;27:495-500. [Crossref] [PubMed]
  35. Yang CF, Meyerhoff RR, Mayne NR, et al. Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg 2016;49:1615-23. [Crossref] [PubMed]
  36. Hireche K, Canaud L, Lounes Y, et al. Thoracoscopic Versus Open Lobectomy After Induction Therapy for Nonsmall Cell Lung Cancer: New Study Results and Meta-analysis. J Surg Res 2022;276:416-32. [Crossref] [PubMed]
  37. Casiraghi M, Bertolaccini L, Sedda G, et al. Lung cancer surgery in oligometastatic patients: outcome and survival. Eur J Cardiothorac Surg 2020;57:1173-80. [Crossref] [PubMed]
  38. Griffioen GH, Toguri D, Dahele M, et al. Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors. Lung Cancer 2013;82:95-102. [Crossref] [PubMed]
  39. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer 2018;103:356-87. [Crossref] [PubMed]
  40. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995;13:8-10. [Crossref] [PubMed]
  41. Ashworth A, Rodrigues G, Boldt G, et al. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer 2013;82:197-203. [Crossref] [PubMed]
  42. Bellomi M, Rizzo S, Travaini LL, et al. Role of multidetector CT and FDG-PET/CT in the diagnosis of local and distant recurrence of resected rectal cancer. Radiol Med 2007;112:681-90. [Crossref] [PubMed]
  43. Yang JC, Wu YL, Schuler M, et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 2015;16:141-51. [Crossref] [PubMed]
  44. Paz-Ares LG, de Marinis F, Dediu M, et al. PARAMOUNT: Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol 2013;31:2895-902. [Crossref] [PubMed]
  45. Genovese E, Canì A, Rizzo S, et al. Comparison between MRI with spin-echo echo-planar diffusion-weighted sequence (DWI) and histology in the diagnosis of soft-tissue tumours. Radiol Med 2011;116:644-56. [Crossref] [PubMed]
  46. Ashworth AB, Senan S, Palma DA, et al. An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer. Clin Lung Cancer 2014;15:346-55. [Crossref] [PubMed]
Cite this article as: Petrella F, Rizzo S, Casiraghi M, Bardoni C, Mohamed S, Musso V, Simonini E, Spaggiari L. State of the art and new perspectives in surgical treatment of lung cancer: a narrative review. Transl Cancer Res 2022;11(10):3869-3875. doi: 10.21037/tcr-22-1491

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