Lung Cancer Surgery Part B: Methods and Results of Extended Pulmonary Resections

The results of resection of non-small cell lung cancer depend on its stage. The 5-year survival of patients with stage I and II non-small cell lung cancer is 70 and 50%, respectively; therefore, surgical treatment is thought to be indicated in these patients. However, in patients with stage IIIa and IIIb non-small cell lung cancer 5-year survival is as low as 20 and 6%, respectively. There are especially few long-term survivors with stage IIIb non-small cell lung cancer. On the other hand, stage IIIb non-small cell lung cancer can be classified into T4 and N3, with the former considered to be operable in selected patients. The symptoms and prognosis of T4 cancer vary depending on the region invaded: trachea, esophagus, vertebral column, superior vena cava (SVC), aorta, left atrium (LA). Good survival rates are obtained by upfront resection (excluding pancoast tumours) of T4 tumours in cases of NO or N1 nodal status and if complete resection is achieved, and resection should be recommended in patients fit for surgery. Therefore, the indications for surgical operation should be determined by taking into consideration the region of invasion, the degree of invasion, lymph node involvement and curability by surgery [1-4]. Most of these cancers are staged T3 or T4. Therefore, it is mandatory that all patients undergo extensive staging, including mediastinoscopy, before an attempt at resection. Operative planning is critical because only a complete resection provides the patient with any opportunity for cure.

Keywords: Lung cancer, extended resection.