Operative staging of lung cancer

For earlier stage non-small cell lung cancer, surgical resection remains the most effective therapy. Complete resection of the primary tumour and lymph nodes should be the final aim in order to obtain the best long-term prognosis. Resectability depends on the tumour stage, and precise pre- and peroperative staging are of the utmost importance. In some cases, lung-sparing or extended operations are indicated. Despite modern scanning techniques, invasive staging by mediastinoscopy or thoracoscopy often remains necessary for determining resectability or deciding on a specific treatment. During thoracotomy, precise evaluation of the tumour and node factor is imperative for determining the extent of resection and achieving a complete tumour clearance. A systematic nodal dissection during thoracotomy is advised. Lung resection after induction therapy remains a technical challenge, especially after combined chemoradiotherapy. Peroperative staging is often difficult as distinction between viable tumour and fibrotic reaction is not easily made. Although combined modality treatment has an overall increased morbidity and mortality rate, it improves survival in selected cases of locally advanced non-small cell lung cancer.