[Surgery of bronchus carcinoma]

Indications for surgical treatment of lung cancer are based on histology and staging of the tumour and on the general condition of the patient.

The current therapy for non-small cell cancer of the lung is operative excision. Small cell cancer however is best treated by chemotherapy or radiotherapy or by both in combination. Small or peripheral small cell cancer should also be removed surgically, but only in combination with chemotherapy or radiotherapy. Stage: Non-small cell tumours, which are assessed to be limited to the thorax and locally resectable have to be removed surgically. If the tumour involves the chest wall, pre- and postoperative radio-therapy is advisable. If lymph nodes in the upper mediastinum or in the contralateral hilus are involved, or if distant metastases are proven, surgical intervention is indicated only in exceptional cases.

The patient's general condition should allow tolerance of thoracotomy and extensive resection of lung parenchyma and adjacent tissue. Adequate ventilatory reserve is mandatory. In this regard it is important to realize that part of the lung may already be excluded from ventilation by obstruction, and resection of such parenchyma does not further impede ventilation. Indeed, resection of non-ventilated segments of lung parenchyma will even improve cardio-pulmonary reserve since the procedure might eliminate pulmonary av-shunting.