ABSTRACT
INTRODUCTION In this review, recent advances in the surgical treatment of lung cancer are presented and discussed. Many controversial issues remain regarding the role of surgery in the diagnosis, staging, and treatment of nonsmall cell lung cancer (NSCLC). The role of invasive staging and restaging techniques are currently debated and their present-day applications are discussed in this chapter. The different types of operative procedures that are available to the thoracic surgeon are also described. In the consideration of the surgical treatment for NSCLC, a distinction has to be made between early stage disease (stages IA/B and IIA/B), locoregionally advanced disease (stages IIIA/B), and metastatic disease (stage IV). The different indications for surgical treatment of NSCLC are discussed according to the recently introduced seventh TNM classifi cation taking into account that surgery for locoregionally advanced disease remains a highly controversial topic. Intraoperative staging of lung cancer is extremely important to determine the extent of resection according to the intraoperative tumor (T) and nodal (N) status. Systematic nodal dissection is generally advocated to determine the precise nodal involvement which not only determines prognosis but also the application of adjuvant therapy. In 2011, a new adenocarcinoma classifi cation was published introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. Its surgical implications including the role of limited resection are discussed. Except for very early stages of NSCLC, combined modality therapy including surgery is more frequently utilized. The impact and infl uence of surgery on prognosis, morbidity, and mortality are discussed in this chapter.
