[The role of extended surgery for lung cancer]

According to the annual report of the Japanese Association for Thoracic Surgery Registry, a total of 1,080 extended lung cancer surgeries combined with resection of neighboring organs were performed in 2010, which was 3.3% of all lung cancer surgeries (32,801 cases). Among the 1,080 extended lung cancer surgeries, 794 cases (73.5%) were T3. The evaluation of the degree of invasion of neighboring organs as well as nodal status is important to determine operability. Surgery is not indicated for cases with mediastinal lymph node involvement because of poor prognosis. Therefore, preoperative mediastinal staging should be performed by the combination of CT and PET as well as invasive methods if N2 disease is suspected. If complete resection is performed and the patient is free of lymph node metastasis, a favorable prognosis may be expected even in those with T4 disease, although the operative risk is high. Further progress is needed in preoperative staging and perioperative combined treatment modalities.