The 2026 American Association for Thoracic Surgery Expert Consensus Document: Evaluation and management of N2+ non–small cell lung cancer

Objective: Multimodal therapy is recommended for the optimal treatment of N2 positive non–small cell lung cancer (NSCLC). Recent advancements in the use of immune checkpoint inhibitors and targeted therapy have dramatically changed the landscape of treatment. We reviewed recent trials and literature to develop consensus statements concerning the evaluation and treatment of potentially resectable NSCLC with N2 involvement. Methods: The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international panel of medical oncologists, radiation oncologists, radiologists, and thoracic surgeons. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with class of recommendation and level of evidence on issues related to the treatment of potentially resectable N2 positive NSCLC. Results: Consensus was reached on 13 statements on topics related to staging, determinants of unresectable disease, use of chemoimmunotherapy or targeted therapies, proper use of neoadjuvant and/or adjuvant therapy, restaging, and the safety of resection after chemoimmunotherapy. Conclusions: NSCLC with N2 disease remains a challenging, heterogeneous disease. These expert consensus recommendations are meant to provide guidance to identify appropriate surgical patients and to formulate the best multimodality treatment of patients with N2-positive NSCLC.