Making precision surgical strategies a reality: Are we ready for a paradigm shift in thoracic surgical oncology?

The original paradigm of precision surgery was born to ensure the best result for each patient with optimization of therapeutic effectiveness, surgical safety and minimal invasiveness – one of the main characteristics of precision surgery includes individualization [1]. The strategy of precision surgery in thoracic oncology is unknown and it should be based on a balance between the removal of the target lesion, invasiveness and individualization of the treatment. The main objective of this paper is to review the state of precision surgery in thoracic cancers based on papers presented during the fifth Mediterranean Symposium in Thoracic Surgical Oncology, and to try to give an answer to many open questions. Moreover, it could be a useful starting point to change the original paradigm and to pose the basis for a new modern oncologic surgical treatment based, not only on the ‘cold’ TNM staging system, but taking into consideration the patient at 360 degrees. TNM classification is a ‘cold’ staging system because it does not take into consideration the character and genomics of the patients. The individual appropriate treatment for the single patient could achieve a longer survival due to a better response of the immune system.