关键词: 早期肺癌, 指南解读, 亚肺叶切除, 淋巴结清扫, 精准外科

Abstract: The surgical treatment of early-stage lung cancer isundergoing a profound paradigm shift from standardized resection to precision,individualized resection.In 2026,the Chinese Medical Association and the Chinese Society of Clinical Oncology updated their clinical guidelines for early-stage lung cancer.The surgical updates focus on three dimensions.First,the indications for sublobar resection have been significantly expanded.Based on a triple-screening criterion of tumor diameter ≤2 cm,consolidation-to-tumor ratio ≤0.5,and intraoperative frozen section confirmation of adenocarcinoma in situ or minimally invasive adenocarcinoma,sublobar resection has been upgraded from a “compromised choice” to a preferred procedure for selected populations.Second,mediastinal lymph node dissection has been adjusted from systematic dissection to a risk-stratified strategy based on imaging characteristics and pathological assessment,representing a critical transition from “sweeping” to “selective” dissection.Third,a standardized intraoperative frozen pathology decision-making pathway has been established,requiring an efficient intraoperative multidisciplinary collaboration between thoracic surgery and pathology departments.This article systematically interprets the evidence basis for these updates,reviews long-term follow-up data from key studies including JCOG0802,CALGB140503,and ACOSOG Z0030,analyzes controversial issues in clinical practice,and discusses future directions including AI assisted decision-making and liquid biopsy-guided precision surgery.

Key words: early-stage lung cancer, guideline interpretation, sublobar resection, lymph node dissection, precision surgery