Surgical therapy of early non-small cell lung cancer

Approximately 45% of all lung carcinomas are limited to the chest, where surgical resection is not only an important therapeutic modality, but in many cases, the most effective method of controlling the disease. Patients with T1N0 and T2N0 tumors have early lung cancer, and most are curable by resection, with 5-year survival rates in the range of 75 to 80% for patients with T1N0 status. Patients with smaller tumors do better than patients with larger ones, while visceral pleural invasion does not seem to influence survival. Histologic type is also a significant prognostic variable, with squamous tumors having a better prognosis than tumors of nonsquamous histology. Other known prognostic factors are age and gender of the patient and completeness of resection. The "gold standard" of surgery remains lobectomy, regardless of tumor size at presentation. Stage T1N1 and T2N1 carcinomas represent a group of patients where the disease involves hilar and bronchopulmonary nodes. This group is best treated by complete resection with mediastinal lymphadenectomy. Tumor size and histology are significant prognostic variables, and 5-year survival after complete resection is in the range of 40 to 50%. Postoperative radiation therapy may improve local control, while chemotherapy results in a slightly reduced risk of death.