The expert consensus document on minimally invasive upper lobectomy for lung cancer in China

Background: Minimally invasive upper lobectomy is recognized as a standard surgical intervention for non-small cell lung cancer (NSCLC). Nevertheless, there is a paucity of evidence-based technical standards regarding anatomical sequences, the scope of lymphadenectomy, and perioperative management in the context of upper lobectomy.

Methods: A multidisciplinary team comprising thoracic surgeons from 12 tertiary centers across China was assembled. A systematic review of evidence from 33 randomized controlled trials (RCTs) and 11 additional studies specific to the upper lobe [1996–2026] was conducted. Recommendations were developed in accordance with the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework, employing a modified Delphi consensus process. The study protocol was prospectively registered under PREPARE-2026CN207.

Results: The consensus resulted in the formulation of nine graded statements. Strong recommendations (grade A) advocate for video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS) as the standard surgical techniques, with the requirement for systematic lymphadenectomy. Moderate recommendations (grade B) delineate optimal airway management, enhanced perioperative care protocols, and customized nodal dissection strategies. These strategies specifically differentiate between early-stage ground-glass opacity (GGO) dominant tumors and invasive carcinoma to inform selective omission of lymph node stations. Expert consensus (grade C) defines surgical indications and establishes standardized anatomical dissection sequences for upper lobectomies.

Conclusions: This consensus provides a comprehensive, evidence-based framework for the standardization of minimally invasive upper lobectomy in NSCLC. Although core surgical approaches and systematic lymphadenectomy are supported by high-level evidence, tailored nodal management and anatomical sequencing remain dependent on expert consensus, underscoring essential directions for future clinical trials.