Selecting patients with lung cancer for surgical therapy.

Abstract

URGICAL RESECTION offers the best and arguably the only means by which non-small cell lung cancer can be cured. The emphasis in dealing with a newly diagnosed lung cancer patient should therefore be directed towards evaluating the individual patient’s operability and resectability. With the ever increasing incidence of lung cancer, this strategy also holds applicable in the undiagnosed patient with signs or symptoms suspicious for lung cancer. In this report we will propose a present day strategy for identifying patients who may potentially benefit from surgical resection, and then outline surgical principles and techniques necessary to not only afford the best possible surgical result but also to provide the most definitive pathologic staging. This precise staging is now mandatory for meaningful evaluation of the many adjuvant therapies becoming available for treating lung cancer patients.’ Before presenting what admittedly is an aggressive surgical approach to lung cancer, three points need to be stressed: 1. Non-small cell lung cancer can be definitively cured by surgical resection with predictable certainty when staging techniques are routinely used. With the results of these staging procedures in hand, the physician can present a relatively accurate appraisal of an individual patient’s chance for curative resection prior to major surgery. In broad terms this translates into 5-year survival rates of 60% to 80% for Stage I disease, 40% to 60% for Stage II, 20% to 40% for Stage IIIA and ~20% for Stage IIIB disease. Unfortunately, ~30% of newly diagnosed patients with lung cancer will fall into one of the favorable survival groups, thus accounting for the barely perceptible increase in overall 5-year survival of lung cancer patients from 7% to 13% during the past 35 years2