[Quality standards for resection of non-small cell lung cancer]

Surgical resection remains the only curative treatment option for non small cell lung cancer. In contrast to other modalities (chemotherapy, radiation therapy) where the benefit is modest, there are no universally accepted guide-lines for quality. Several studies have demonstrated that the best results in terms of operative mortality and long term survival are achieved by specialized surgeons working in high volume institutions. The basic principle of operative treatment is a combination of anatomic resection and radical ipsilateral lymph node dissection. Lymph node dissection ascertains adequate nodal staging and recent research has found that it is associated with an increased in the medium term. The usual mortality rate is about 2% after lobectomy and 6-10% following pneumonectomy. Given the high operative risk of pneumonectomy, extended lobectomies with bronchoplasty or angioplasty are valuable alternatives, provided that a complete resection is achieved. Anatomic segmentectomy may be an alternative to lobectomy in selected patients with peripheral tumors of less than 2 cm in diameter. There is no evidence that neo-adjuvant chemotherapy increases the risk of pneumonectomy.