[Standards of surgery in lung cancer]

Surgery has a pivotal role in the treatment of bronchogenic carcinoma. Indeed, resection is the standard treatment of early stages (I & II) non-small cell lung cancer, remains optional for a portion of patients with a locally advanced disease (IIIA & IIIB) and in anecdotal carefully selected patients with an oligometastatic disease (IV). In France, this surgery is framed by strict regulations. It is performed by qualified surgeons only, in authorized institutions, on the basis in particular of a minimal volume activity. The current risk of postoperative death is less than 5%, and the probability of 5-year overall survival exceeds 60% in stage I patients. The standard surgical approach is an open thoracotomy. In poor-risk patients with stage I disease who are considered appropriate candidates for thoracoscopic anatomic lung resection, the use of video-assisted techniques is an acceptable alternative to open thoracotomy. In patients who are medically fit for conventional surgical resection, lobectomy or greater resections are recommended. Systematic mediastinal lymph node dissection should be performed for accurate pathologic staging and treatment. The practice of extended resections to mediastinal structures should be regionalized and reserved to high volume expert teams. The effort of standardization of surgical practices and the prospective collection of their results are necessary prerequisites for the evaluation of the quality of care.