[Surgical operability of patients with locally advanced non-small cell lung cancer (NSCLC)]

Local advanced NSCLC are not rare and consist of a heterogeneous group of diseases. Surgery can be offered to high selected patients. In most of the cases, the therapy concept is multidisciplinary, combining surgery with chemotherapy, radiotherapy, or both of them. Such a concept, in which surgery plays a central role, is very often the only way to treat the patient in a curative intention. Unfortunately, in T4-tumors, distant metastases and an extensive involvement of the mediastinal lymph nodes are already present at the time of diagnosis in most of the cases. In such palliative situations, surgery is not indicated. The most important factor to select patients for surgery is the possibility to perform a radical complete resection of the tumor. The standard resection consists of an en-bloc resection of lung tissue with the infiltrated neighbouring structure. The prognosis depends on the radicality of the resection and of the lymph node status. The best results are observed in patients with isolated infiltration of the chest wall, with tumors of the sulcus superior, and infiltration of the superior vena cava. 5-y overall survival up to 40 - 50% can be observed after complete resection in N0-patients. The prognosis is poorer in patients with infiltration of the carina, of the spine and of the atrium, with 20 - 30% in small series. Local advanced NSCLC should only be treated in reference centres. Only in such centres, the interdisciplinary approach and the optimal therapy can be guaranteed with a minimal morbidity and mortality.