[Current indications for early surgery in stage III non-small-cell bronchial cancer]

In a number of cases, surgery is carried out as the initial procedure in Stage III non small cell carcinoma. For those with Stage IIIA surgery is the initial procedure performed by practically all teams for Stage T3 chest wall and T2 bronchial stump in patients who have non evidence of N2. In Stage IIIA N2 which is histologically confirmed by mediastinoscopy or thoracoscopy surgery is the initial procedure in certain cases if the local conditions are "favourable". The majority of surgical teams however prefer to operate after neo-adjuvant therapy whose long term efficacy still remains to be shown in a formal study. Stage IIIB consists of a very heterogeneous group in whom surgery can be carried out as an initial procedure in a limited number of cases such as involvement of the left auricle, the proximal pulmonary artery, the superior vena cava, the oesophageal muscle as well as at the carina. In all the other cases of IIIB on the CT scanner or MRI scanner where the cancer seems to be non resectable, or resectable in a poor clinical situation, one would envisage surgery only after a re-evaluation secondary to neo-adjuvant therapy.