Cancers bronchiques non à petites cellules opérables : voies d'abord et techniques chirurgicales en 2014

Lung surgery for non-small cell lung cancer (NSCLC) is currently based on anatomical pulmonary resections tailored to tumor size and tumor location in order to achieve a complete resection associated to a lymphadenectomy. Since the last guidelines of the French society of thoracic and cardiovascular surgery (FSTCVS) in 2009, we have faced the development of new surgical techniques of approaches and parenchymal resections. Surgical approaches are moving toward minimally invasive procedures especially for early stage tumors. These surgical approaches include video-assisted thoracic surgery (VATS), robotic-assisted thoracic surgery (RATS) and single-port surgery. Limited, so-called sublobar, resections (segmentectomy) have been revived from the old times of tuberculosis surgery, and are expected to increase with the high proportion of lung abnormalities detected with low-dose spiral computed tomography scan such as small nodules and ground glass opacities along with the implementation of screening programs. Conservative surgical resections (angio and/or bronchoplastic lobectomies) have been refined to allow avoidance of pneumonectomy. At last, benefits of a systematic lymphadenectomy compared to sampling have been put back into question in a subgroup of patients with early stage cancer.