[Standardization of lung cancer surgery]

A lobectomy with systematic nodal dissection is accepted as the standard radical operation for early-stage lung cancer. When this was established as the standard operation, there was little evidence to confirm that the results after a lobectomy with systematic nodal dissection were superior to those after other procedures. Most thoracic surgeons accepted lobectomy with systematic nodal dissection as the gold standard for lung cancer surgery. Therefore, no randomized, controlled study was conducted to confirm the justification for that procedure. However, numerous reports of nonrandomized trials or practices were published to justify its acceptance as the standard radical operation for stage IA lung cancers. On the other hand, advances in diagnostic equipment including helical computed tomography (CT), magnetic resonance imaging, and position-emission tomography rapidly changed the concept of early-stage lung cancers. Detection of ground glass attenuation by CT and the introduction of the new pathological concept of localized bronchioloalveolar cell carcinoma as an extremely early-stage lung cancer encouraged surgeons to start clinical trials to obtain evidence. Those efforts will create a new standard for lung cancer surgery. Finally, patients will choose a procedure after consideration of his or her own personal situation excluding medical condition. The procedure selected by most patients will become the gold standard. The gold standard will change with changes in society.