Approach to Borderline Operable NSCLC
Dr Soon Sing Yang, Sarawak Heart Centre

NSCLC resectability is determined by 3 main factors, namely size, location and stage at presentation. Traditionally, large localised central tumour is removed via pneumonectomy. In recent times, a wide variety of surgical techniques such as bronchoplasty or angioplasty procedures are used for parenchymal sparing resections. The primary goal is to achieve an R0 resection whereby the lung cancer is removed with clear margins and all the appropriate lymph nodes stations are dissected for accurate pathological staging whilst preserving as much lung tissue as possible.

For advanced stage (stage 3) NSCLC, neoadjuvant chemotherapy +/- radiotherapy might be used to downstage and downsize advanced stage NSCLC to try to achieve clear margins. The response rate to such neoadjuvant therapies is highly variable. In recent years, there is increasing evidence and availability of neoadjuvant targeted therapy and immunotherapy to achieve a more consistent response rate in the appropriate group of patients.

With more effective systemic therapies coming online in the near future, even stage 4 patients with oligometastasis or even oligoprogression might be deem to be resectable. There are also upcoming technologies that allow resection/ablation to be carried out with minimal morbidity.