Evolution of Mode of Surgery for Lung Cancer: Historical Moment

The mode of surgery for lung cancer has been changed in these 100 years. The first surgery for lung cancer was performed as a pneumonectomy in 1933. The standard pulmonary lobectomy was established in 1960, and then thoracic surgeons in the United States tried to minimize pulmonary parenchyma resected for lung cancer. The first randomized controlled trial was done comparing lobectomy and sublobar resection for lung cancer in 1995. The result was negative; that meant lobectomy was still the standard surgery for lung cancer. Due to the failure of the trial, the thoracic surgeon had to perform a lobectomy even for subcentimeter lung cancer. In the late 1990s, thin-section computed tomography was found to be useful for grading lung cancer preoperatively, and early peripheral lung cancer was defined by the results. As a result, investigations of sublobar resection were conducted in two ways: wedge for early lung cancer and segmentectomy for invasive lung cancer. After several clinical trials, such as JCOG0201, JCOG0802/WJOG4607L, and JCOG0804/WJOG4507L, the standard mode of surgery for lung cancer 2 cm or less in size was set to sublobar resection in 2023. Nowadays, sublobar resections are investigated for additional indications such as bigger tumors and lung cancer having nodal metastasis. Selection of mode of surgery for patients should be decided based on patients’ tolerability for surgery as well as tumor characteristics. In this aspect, artificial intelligence would be used for the selection in the near future.