State of the art treatment of lung cancer: non-small cell lung cancer--surgical treatment

Surgery is defined as purely a local treatment modality. In the treatment of non-small cell lung cancer, surgery remains the first-line treatment of choice for local diseases. Thus, stages I, II, and a part of IIIA disease are definite indications for surgical therapy. The standard operative mode in curative intent for such local diseases is the resection of the entire lobe or lung where the cancer is located. The prognostic significance of hilar/mediastinal lymph node dissection remains controversial, although it can provide the most accurate information regarding the metastatic status of hilum and mediastinum. For locally advanced diseases of stages IIIA and IIIB, the surgical approach still remains investigational in a combined modality setting. For N2 diseases (with mediastinal node metastasis), the prognostic benefit of both preoperative and postoperative chemo (-radio) therapy has not been definitively demonstrated yet, although several reports suggested their potential benefits. They await further evaluation by clinical trials in a phase III setting. Although aggressive surgical approaches for tumors invading surrounding vital structures (IIIB disease) have been reported, it is also still uncertain whether their results can really exceed those obtained by chemoradiotherapy.