Chest
Non-small Cell Lung Cancer: Role of Surgery for Stages I-III
Section snippets
Diagnosis and Staging
Accurate diagnosis and histologic classification are made with the assistance of imaging techniques (including CT, MRI, positron emission tomography [PET], and bone scans), sputum cytology, needle biopsy, bronchoscopy, thoracoscopy, mediastinoscopy, bone marrow biopsy, and blood tests. Video-assisted thoracoscopic surgery is also becoming popular due to demonstrated diagnostic accuracy and the ability of the surgeon to visualize the entire lung, pleura, and mediastinum.
In 1997, the
Indications for Resection
The goal of surgery in NSCLC is to provide complete resection of the primary tumor with no macroscopic tumor remaining and microscopically free margins. Only patients in whom a complete resection is anticipated are selected for surgery. These include patients with T1 to T4, N0 and N1 tumors and selected N2 cases. Multiple primary lung cancers can be resected with a reasonable prospect of survival if the tumors appear completely resectable. Survival following metachronous cancer resection has
Limited Resection
Standard resections for primary lung cancer are pneumonectomy, lobectomy, and sleeve lobectomy in selected cases. Lesser or limited operations include wedge resection, segmental resection, nonanatomic limited resection, and sleeve lobectomy. Advantages for these lesser resections include preservation of pulmonary function, decreased perioperative mortality and morbidity, and the potential for future further pulmonary resection, if necessary. In patients with equivocal levels of pulmonary
Indications for Adjuvant Therapy
The current status of adjuvant and neoadjuvant trials in NSCLC were recently reviewed by Einhorn,43 who concluded that no survival benefit is observed following postoperative adjuvant radiotherapy, chemotherapy, or chemoradiation. At present, there is no clear indication for adjuvant therapy in surgically resected cases other than in the context of a clinical trial. In contrast, three studies have demonstrated improved survival following neoadjuvant therapy,44, 45, 46 although the case numbers
Summary
For patients with lung cancer, surgical resection provides the best possibility of cure in selected patients. It is again emphasized that surgical resection is only applicable for patients in whom a complete resection is deemed possible. Accurate diagnosis and staging maximizes this potential. Comprehensive evaluation of nodal status is imperative. Extended resection can be effective in locally advanced disease, with worthwhile survival possible in patients whose tumors are completely resected.
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Overall survival in low-comorbidity patients with stage I non–small cell lung cancer who chose stereotactic body radiotherapy compared to surgery
2024, Journal of Thoracic and Cardiovascular SurgerymiRNA profiling of primary lung and head and neck squamous cell carcinomas: Addressing a diagnostic dilemma
2017, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Patients with a history of HNSCC and the presence of lung metastases are considered to have advanced-stage cancers, and treatment will usually be aimed at palliation.10 In contrast, if the same patient is diagnosed with a primary LSCC, this would be considered an early-stage lung cancer, which will have a better prognosis, with treatment focused on surgical resection with curative intent.11 This differentiation also will help determine the appropriate surgical extent: for cases with lung metastases from HNSCC, a tissue-sparing, nonanatomical resection is indicated, such as metastasectomy or wedge resection, whereas the standard of care for a primary, early-stage lung cancer is a more extended or anatomical resection such as segmentectomy, lobectomy, or pneumonectomy, which have better survival rates but still possess considerable risk for complications.4
Postoperative complications after thoracic surgery for lung cancer
2015, Clinical ImagingCitation Excerpt :In this article, we describe the radiographic and computed tomography (CT) appearances of postoperative complications following thoracic surgery for lung cancer. In the management of NSCLC, surgery has the highest curative potential and is the treatment of choice for patients with Stages I and II and selected Stage III disease [3]. There are four principal types of lung resection: wedge resection, segmentectomy, lobectomy, and pneumonectomy (Table 1).
Lymph node dissection for lung cancer significance, strategy, and technique
2009, Journal of Thoracic OncologyCitation Excerpt :This nonrandomized study showed that SND significantly improved the survival of patients with stage II–IIIa non-small cell lung cancer. Moreover, some other retrospective studies have shown the survival benefit of nodal dissection.29–33 The survival benefit of lymph node dissection for patients with lung cancer, however, has not been statistically clear, simply because few prospective randomized controlled trials (RCTs) have been conducted comparing SND with nodal sampling (Table 1).34–36