Anatomical lung resection after neoadjuvant chemoradiotherapy

The critical role for anatomical lung resection -- segmentectomy, lobectomy, pneumonectomy -- in the treatment of Stage I and II non-small cell lung cancer is undisputed. In contrast, the primacy of surgery in the management of Stage III disease is not established. Increasingly, however, the multimodality approach to locally advanced lung cancer has gained acceptance, and the integration of surgery into the treatment algorithms for Stage III cancers, particularly N2 spread, has evolved. Herein, the important steps in this evolution are defined. The concept of induction or neoadjuvant chemoradiotherapy followed by resection is emphasized, and evidence supporting surgery's therapeutic value in this schema is provided. Our center's strategy for the successful and safe delivery of trimodality care is comprehensively outlined.