Current surgical strategies for lung cancer with a focus on open thoracotomy and video-assisted thoracic surgery

The surgical treatment of the lung was developed primarily for pulmonary tuberculosis until the 1960s but was used for primary lung cancer in the 1970s. The incidence of lung cancer will increase in the next 30 years worldwide, and the annual incidence of lung cancer in Japan is expected to increase to about 150,000 by 2015. Over the past 50 years, pulmonologists have performed clinicopathological studies in an attempt to prevent lung cancer. Early detection became possible with such studies; as a result, the rate of detection of lung cancer at stage I has increased. Furthermore, the frequencies of histological detection of peripheral squamous cell carcinoma and adenocarcinoma have increased. Thoracic surgeons have developed techniques, such as limited pulmonary resection, and have established a minimally invasive approach to the thorax. These successes were followed by the development of thoracoscopic surgery. However, minimally invasive surgery that allows for functional preservation has not yet been developed. Future investigations and the refinement of technologies are needed.