Surgery for non-small cell lung cancer--new trends

New trends in lung cancer surgery focus on new approaches to the management of the primary tumour, combined modality approaches to both local and distant control of the tumour, new approaches to ensure resectability by staging and techniques to expand the limits of operability. With new screening methods for NSCLC there is a trend toward sublobar, segmental resections of smaller tumours including an expanding use of video assisted thoracoscopy. Improvements in surgical and anaesthetic procedures have stimulated a renewed interest in the resection of locally advanced tumours. The understanding that local control alone may not give the best chance of long term survival has stimulated new trends in the use of neoadjuvant and adjuvant chemotherapy. There is a trend towards more detailed preoperative and intraoperative nodal staging in NSCLC, including video assisted techniques, and the identification of sentinel lymph node involvement to direct lymph node dissection. Increased understanding of the physiological benefits of surgery in emphysema have resulted in a re-evaluation of the selection of patients for lung cancer surgery. This together with a greater application of bronchoplastic and angioplastic techniques is leading to greater resection rates.