In the hands of experienced surgeons bronchial and bronchovascular sleeve resections are safe operations for high-risk patients. There is no statistical significance between N1 and N2 disease with regard to long-term survival. Systematic lymph node dissection does not lead to increased perioperative risk. Sleeve resections have little effect on pulmonary function. Preoperative FEV (1) and lung perfusion can be achieved by 6 months after surgery.

In selected TNSGCT patients with residual masses, RTR can be performed safely after CT. RTR should be attempted at all sites because of possible discordant histological differentiation. Complete and parenchyma-sparing resections are associated with excellent long-term survival, which can be influenced by the surgeon.

Solitary pulmonary nodules (SPN) are radiologically defined as intraparenchymal lung lesions not bigger then 3 cm. In general all pulmonary nodules should be considered malignant until proven otherwise. Primary peripheral lung cancer is the most common cause, at 40%. The probability that an SPN is malignant increases with patient age. Spiral chest CT is the ideal imaging to indicate the precise anatomical location and expose other pathological findings. Malignant SPN can also persist without change for over 2 years. Only complete histological examination can exclude malignance. Therefore every SPN should be resected in operable patients. The surgical risk of video-assisted pulmonary resection and diagnostic thoracotomy is low. For patients who are not operable, other diagnostic procedures such as transthoracic needle aspiration or positron emission tomography may be helpful.

Background Neoadjuvant immunochemotherapy is currently being tested in pivotal trials for stage I-III NSCLC. The impact of immunochemotherapy in patients with oligometastastic disease remains undefined. This study aimed to compare the outcomes of radical treatment after the neoadjuvant course of immunochemotherapy versus chemotherapy. Methods We retrospectively analyzed patients with oligometastastic disease who were treated with immunochemotherapy or chemotherapy combined with local ablation of metastases and radical primary tumor resection between 2017 and 2021. Group A included eight patients with immunochemotherapy; Group B included seven patients with chemotherapy. Descriptive statistical analysis included the characteristics of the patients, tumors, and outcomes. Results There was no difference in postoperative morbidity rates between the groups (p=0.626). The 30-day mortality in both groups was 0%. The median overall survival for Group A was not reached, with a median follow-up time of 25 (range:13-35) months; the median overall survival for Group B was 26 (range:5-53) months. In Group A, all patients remained alive; in contrast, in Group B, four patients died (p=0.026). There was no local thoracic recurrence in either group. In Group B, recurrent disease was identified significantly more often (12.5% vs. 85.75%;p=0.009). The rates of complete and major pathologic response were 37.5% and 0% in Group A and 42.85% and 14.25% in Group B, respectively. Conclusion Despite the small patient number and short-term results, the progression-free and overall survival in patients with oligometastastic disease after local therapy for metastases and primary tumor resection following neoadjuvant course of immunochemotherapy might be promising compared to chemotherapy.

Brain metastases are a common finding upon initial diagnosis of otherwise locally limited non-small cell lung cancer. We present a retrospective case series describing three cases of patients with symptomatic, synchronous brain metastases and resectable lung tumors. The patients received local ablative treatment of the brain metastases followed by neoadjuvant immunochemotherapy with pemetrexed, cisplatin, and pembrolizumab. Afterwards, resection of the pulmonary lesion with curative intent was performed. One patient showed progressive disease 12 months after initial diagnosis, and passed away 31 months after initial diagnosis. Two of the patients are still alive and maintain a good quality of life with a progression-free survival and overall survival of 28 and 35 months, respectively, illustrating the potential of novel combinatorial treatment approaches.