Current principles in the surgical treatment of lung cancer

The success of surgery performed for pulmonary carcinoma is based on the selection of the patients for operation. Cytological or histological verification of the tumour prior to surgery is important as concerns the choice of the type of surgery and the complex antitumour therapy. It is currently considered that patients with tumours in stages I, II and IIIa are suitable for surgery. Operations are also performed in cases involving solitary cerebral metastases, and centrally-lying tumours which reach the bifurcation carina or the lower portion of the trachea (T4) are similar rarely resectable. The basic operation for pulmonary carcinoma is lobectomy. In selected cases of squamous cell carcinomas in stage T1N0, atypical wedge resection too may be considered. Extended surgery is also performed, depending on the size of the tumour. For all types of tumours, it is essential to take a sample from the lymph nodes for accurate staging. Prospective randomized clinical trials on 288 patients undergoing resection for pulmonary cancer revealed that extended medistinal lymphadenectomy improved the 5-year survival rate in cases of adenocarcinomas and squamous cell carcinoma, involving lymph node metastases. Intraoperative cytological examinations or frozen sections are extremely important as concerns the indication of extended mediastinal lymphadenectomy and adjuvant antitumour treatment.