Surgical management of lung cancer

Surgery serves an important role in the diagnosis, staging, and definitive management of non-small cell lung cancer (NSCLC). Resection is the primary mode of treatment for stage I and II NSCLC and an important component of the multimodality approach to stage IIIA disease. Standard resections include removal of the lobe involved with tumor and systematic evaluation of ipsilateral hilar and mediastinal lymph nodes. For early stage disease the evolving surgical treatment goals are aimed at decreasing morbidity and mortality through less invasive approaches including video-assisted thoracoscopic surgery and robotic approaches, and potentially decreasing the volume of lung removed for select patients with well-staged small peripheral tumors. For patients with locally advanced disease, ongoing research is focused on appropriately identifying patients who will most benefit from the addition of surgery to a multimodality regime and safely integrating resection with chemotherapy and radiotherapy.