title: Recent evidence, advances, and current practices in surgical treatment of lung cancer.
abstract: In the last 10-15 years, strategies and modalities of lung cancer treatment have changed dramatically. Meanwhile, the treatment objectives, the lung cancers themselves, have also changed, probably owing to early detection by computed tomography and aging of the population. In particular, the proportions of smaller lung cancers, lung adenocarcinomas with ground-glass opacity, and lung cancers in older patients are increasing. Along with these changes, surgeons have innovated and evaluated novel procedures for pulmonary resection. These include the application of minimally invasive surgical techniques, such as video-assisted thoracoscopic surgery (VATS) and robotic surgery, and sub-lobar resection, such as wedge resection and segmentectomy, for small peripheral lung cancers. Currently, VATS has gained wide acceptance and several institutions in Japan have started using robotic surgery for lung cancers. Two important clinical trials of sub-lobar resection for small peripheral lung cancers are now underway in Japan. In addition, surgery itself is of growing importance in lung cancer treatment. In particular, recent evidence supports the use of surgery in strictly selected patients with locally advanced disease, lung cancers with N2 lymph node metastases, small cell lung cancers, recurrent oligo-metastasis after pulmonary resection, or relapsed tumors after drug treatment. Surgical treatment also provides abundant tumor samples for molecular analysis, which can be used for drug selection in the adjuvant setting or after disease relapse. In the era of personalized treatment, surgery is still one of the most important treatment modalities to combat lung cancer.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: ascaris@surg2.med.kyushu-u.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Suda
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: katsu-sato@surg.med.kindai.ac.jp.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: mizuuchi@surg.med.kindai.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mizuuchi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: ykobayashi@surg.med.kindai.ac.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: mshimoji@surg.med.kindai.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Shimoji
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: ktomizawa@surg.med.kindai.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tomizawa
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: takemoto@surg.med.kindai.ac.jp.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takemoto
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: iwasaki@surg.med.kindai.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Iwasaki
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: msakaguchi@surg.med.kindai.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sakaguchi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. Electronic address: mitsudom@surg.med.kindai.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsudomi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000639:trends*; D058990:Molecular Targeted Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D057285:Precision Medicine / Q000639:trends; D013510:Pulmonary Surgical Procedures / Q000379:methods / Q000639:trends*; D018714:Radiotherapy, Adjuvant; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted
keywords: Adjuvant chemotherapy; Multimodality treatment; Salvage surgery; Sub-lobar resection; Video-assisted thoracoscopic surgery (VATS)