{"entity":{"id":"resectability-lung-cancer","kind":"term","name":"Resectability in lung cancer","aka":["resectable lung cancer","operable lung cancer","technically resectable","medically operable","unresectable lung cancer"],"tldr":"Two separate questions are hidden in the word operable. Can the tumour be removed completely with a margin, which is anatomy? And can this person survive the operation and live without the lung tissue it takes, which is physiology? A no to either makes the cancer unresectable, for different reasons and with different alternatives.","summary":"Technical resectability is about where the tumour and its nodes are. Disease confined to one lung with hilar or single-station mediastinal nodes is usually removable; multi-station or contralateral mediastinal nodes, invasion of the great vessels, the heart, the carina or the vertebral bodies, and any metastasis outside the chest are usually not. The ninth edition of TNM, in force since January 2025, sharpened exactly this boundary by splitting N2 into N2a, a single ipsilateral mediastinal or subcarinal station, and N2b, multiple stations, and by moving T1N2a into stage IIB and T3N2a into IIIA; which side of that line a patient falls now depends on a systematic sampling of the mediastinum by endobronchial or oesophageal ultrasound, which is why NICE asks for it whenever the nodal stage would change treatment. Medical operability is about the person: lung function measured by spirometry and gas transfer, predicted postoperative function after the planned resection, exercise capacity, cardiac risk and performance status. The two are decided by different members of the multidisciplinary team, and a patient can be told the tumour is removable and the operation is not safe in the same meeting. The alternatives differ accordingly: stereotactic ablative radiotherapy for a small peripheral tumour in someone who cannot have surgery, and chemoradiotherapy for disease that is anatomically unresectable. NICE NG122 records that no randomised trial settles surgery against stereotactic radiotherapy where surgery is suitable, and lists that comparison among its recommendations for research.","asOf":"2026-09-25","wikipedia":"https://en.wikipedia.org/wiki/Lung_cancer_surgery","links":[{"label":"NICE NG122: lung cancer, diagnosis and staging (published 28 March 2019, last updated 8 March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging"},{"label":"Rami-Porta, J Thorac Oncol 2024: IASLC lung cancer staging project, proposals for revision of the TNM stage groups in the forthcoming ninth edition (76,518 patients analysed of 124,581 registered)","url":"https://doi.org/10.1016/j.jtho.2024.02.011"},{"label":"Br J Radiol 2025: something old something new, introduction to the ninth edition TNM classification of lung cancer (effective 1 January 2025)","url":"https://doi.org/10.1093/bjr/tqaf161"}],"tags":["lung"],"related":[],"cancers":["nsclc","lung-cancer","lung-lcnec","sclc"],"sections":[],"technologies":["sbrt","ct","pet"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["resectability","performance-status","tnm-9-lung-cancer","ebus-tbna","mediastinal-lymph-node-stations"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Clinical"},"route":"/terms/resectability-lung-cancer/","neighbours":{"cancer":[{"id":"lung-lcnec","kind":"cancer","name":"Large cell neuroendocrine carcinoma of the lung","route":"/cancers/lung-lcnec/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"technology":[{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"},{"id":"pet","kind":"technology","name":"PET (positron emission tomography)","route":"/technologies/pet/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"term":[{"id":"ebus-tbna","kind":"term","name":"Endobronchial ultrasound (EBUS-TBNA)","route":"/terms/ebus-tbna/"},{"id":"mediastinal-lymph-node-stations","kind":"term","name":"Mediastinal lymph node stations","route":"/terms/mediastinal-lymph-node-stations/"},{"id":"pancoast-tumour","kind":"term","name":"Pancoast (superior sulcus) tumour","route":"/terms/pancoast-tumour/"},{"id":"performance-status","kind":"term","name":"Performance status (ECOG, Karnofsky)","route":"/terms/performance-status/"},{"id":"resectability","kind":"term","name":"Resectable, borderline resectable and unresectable","route":"/terms/resectability/"},{"id":"spread-through-air-spaces","kind":"term","name":"Spread through air spaces (STAS)","route":"/terms/spread-through-air-spaces/"},{"id":"sublobar-resection","kind":"term","name":"Sublobar resection (segmentectomy and wedge)","route":"/terms/sublobar-resection/"},{"id":"tnm-9-lung-cancer","kind":"term","name":"TNM 9: what changed in lung cancer staging","route":"/terms/tnm-9-lung-cancer/"}]}}