Journal of Thoracic Oncology 20th Anniversary Series Surgery.

In the last 20 years, major changes have occurred in the diagnosis and management of thoracic oncologic pathology. Furthermore, thoracic surgery has undergone considerable changes since the inception of the Journal of Thoracic Oncology in 2006. Regarding staging of lung cancer, pleural mesothelioma, and thymic epithelial tumors, several revisions were implemented in the TNM classification. The recently published ninth edition represents a tremendous effort of the Staging and Prognostic Factors Group of the International Association for the Study of Lung Cancer to analyze worldwide survival data and to validate the proposed changes in newly designed categories. Complete resection of a lung cancer remains an underestimated but important prognostic factor, and current attention is directed to technical resectability within multimodality therapy for locoregional advanced lung cancer. Integration of surgery within protocols of neoadjuvant, adjuvant, and perioperative therapies is further evaluated to determine the optimal therapeutic strategy. For smaller lesions less than or equal to 2 cm, sublobar resection, comprising segmentectomy and wide wedge excision, has been proven to be an alternative to lobectomy in specific subgroups. In the last 20 years, minimally invasive techniques have been introduced to provide new approaches to the thoracic cavity, especially for early stage lung cancer. Interventions performed by video- or robotic-assisted thoracic surgery are associated with a clear clinical benefit without compromising oncologic outcome. The role of thoracic surgery for resectable lung cancer cases has been firmly established, and surgery has become an integral part of multimodality therapy, but undoubtedly, further refinements will be made in the forthcoming 20 years!