From "maximum tolerated intervention" to "minimum effective treatment": four decades of evolution and transformation in lung cancer surgery in Shanghai

@article{tong2026from,
  title = {{From "maximum tolerated intervention" to "minimum effective treatment": four decades of evolution and transformation in lung cancer surgery in Shanghai}},
  author = {LI Tong and ZHANG Yang and CHEN Haiquan},
  journal = {Zhongguo aizheng zazhi},
  year = {2026},
  month = sep,
  url = {http://www.china-oncology.com/zh/article/doi/10.19401/j.cnki.1007-3639.2026.09.002/},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - From "maximum tolerated intervention" to "minimum effective treatment": four decades of evolution and transformation in lung cancer surgery in Shanghai
AU  - LI Tong
AU  - ZHANG Yang
AU  - CHEN Haiquan
PY  - 2026
DA  - 2026/09/01
JO  - Zhongguo aizheng zazhi
UR  - http://www.china-oncology.com/zh/article/doi/10.19401/j.cnki.1007-3639.2026.09.002/
AB  - Over the past four decades since the establishment of the Shanghai Anti-Cancer Association, lung cancer surgery has undergone a profound transformation from experience-based practice to evidence-guided decision-making, from maximal resection to individualized parenchymal preservation, and from a sole focus on tumor removal to a broader concern for long-term survival and quality of life. Four decades ago, lung cancer mostly presented as advanced, centrally located, smoking-related disease, and surgical treatment relied mainly on thoracotomy with lobectomy or pneumonectomy and systematic lymph node dissection. With the development of low-dose computed tomography screening, high-resolution imaging, the 2015 World Health Organization (WHO) classification of lung adenocarcinoma, intraoperative frozen section pathology, minimally invasive techniques, and multidisciplinary care, early-stage lung cancer, particularly ground-glass opacity (GGO)-type lung cancer, has gradually become a major focus of thoracic surgical practice. Chinese lung cancer surgical practice, represented by Shanghai, has addressed emerging issues of the screening era at an early stage, including lung cancer in nonsmoking women, screening strategies with a younger starting age and lower frequency, and the management of pulmonary nodules and GGOs, and has developed a distinctive research system centered on the surgical curative time window, minimally invasive surgery 3.0, sublobar resection, selective lymph node management, and active surveillance of multifocal GGOs. The intraoperative frozen section study published in J Clin Oncol in 2016 moved the new pathological classification of lung adenocarcinoma from postoperative reporting to intraoperative decision-making, providing important evidence for individualized resection strategies for small lung adenocarcinomas; the series of studies from the Japan Clinical Oncology Group (JCOG), the Cancer and Leukemia Group B (CALGB), and the Eastern Cooperative Thoracic Oncology Projects (ECTOP) have further driven early lung cancer surgery from "habitual extension" toward "evidence-based restraint". This article reviews the changes in surgical concepts, disease spectrum, and evidence system of lung cancer surgery over the past 40 years, focusing on the natural history of GGO-type lung cancer, the boundary between undertreatment and overtreatment, and the proposal of the surgical curative time window and its significance for future precision management. In the future, lung cancer surgery should continue to advance along the curative time window, the integration of imaging, pathology, and molecular information, artificial intelligence-assisted risk assessment, and long-term quality-of-life evaluation, so that treatment can move from "as sufficient as possible" toward "precisely appropriate".
SN  - 1007-3639
ER  -