The role of surgery for locally advanced non-small cell lung cancer

Accurate clinical staging of patients with locally advanced non -small cell lung cancer (NSCLC) is critical in identifying surgical candidates, who are typically patients with stage N2 disease. Preoperative staging by 18(F)-fluorodeoxyglucose-positron emission tomography can alter staging and therefore influence the selection of therapy. The staging evaluation should include an assessment of the mediastinal lymph nodes; mediastinal lymph node involvement is a negative prognostic indicator. When the treatment plan potentially includes surgery, multidisciplinary evaluation including physiologic evaluation is essential, as surgery is aggressive with potential morbidity. Multimodality therapy offers the best chance for improved progression-free and overall survival. Patients with potentially resectable NSCLC who are downstaged following induction chemotherapy have a superior prognosis compared with those whose stage is unaltered.