Non-small-cell lung cancer involving the pleura: a narrative review on the diagnostic and therapeutic pathway

Visceral pleural invasion (VPI) is considered a challenging topic in the management of patients with non-small-cell lung cancer (NSCLC) since it has been incorporated into the last edition of tumor, node, metastasis (TNM) staging as a size independent T2 factor. VPI presents adverse outcomes and poorer prognosis, with higher rate of mediastinal lymph node metastases and malignant pleural effusion. In literature few studies investigated it, therefore there is still debate on the global management of these patients, from the preoperative staging to the optimal surgical procedure and the postoperative follow-up or the need of adjuvant chemotherapy. Our work is a narrative review taking into consideration the most recent and relevant articles concerning VPI and NSCLC. We have summarized the most appropriate diagnostic pathway, surgical approach and post-operative management in order to give these patients the best therapeutic option. The preoperatively prediction of pleural invasion is still too weak to ensure a preoperative upstaging. On the other hand, lobectomy with adequate lymph node dissection seems to be the most appropriate therapeutic option in these patients. Furthermore, there is no evidence of the usefulness of adjuvant chemotherapy and the lack of clinical trials leads clinicians to evaluate case-by-case the global management of these patients.