Abstract
Early in the history of thoracic surgery, attempts were made to classify patients as to the extent of disease, in order to avoid unnecessary surgery. Evarts A. Graham,1 the surgeon who first successfully removed a carcinomatous lung in 1933, listed in 1944 the following signs of inoperability: (1) the presence of a bloody pleural effusion; (2) paralysis of the ipsilateral hemidiaphragm; (3) paralysis of the left vocal cord; (4) severe pain in the thoracic wall or down the arm; (5) bronchoscopic evidence of extension of the tumor into the trachea; (6) the presence of distant metastases; and (7) advanced age is not an absolute contraindication.
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