Surgical treatment of non-small cell lung cancer

Introduction Surgery remains the best option for curative treatment of early stages Non-small cell lung cancer (NSCLC). In this article we review the current status and future perspectives of surgical treatment of NSCLC. State of art An important part of the surgical procedure is the final determination of the staging with evaluation of the resectablity of the tumor and its nodal status. This requires a systematic hilar and mediastinal nodal dissection and a complete resection that remains a major prognostic factor. Perspectives In order to preserve pulmonary function, lobectomies with the use of broncho- or arterioplasty have been developed with reduction in the number of pneumonectomies. For peripheral T1NO NSCLC, videoassisted (VATS) lobectomy has become technically feasible with survival, in non-randomised studies, at least as good as the survival after open resection. While VATS has a clear role in staging of lung cancer, its role in the treatment of lung cancer however remains debatable. In case of involved mediastinal nodes (N2 disease) induction therapy is given in many centers and patients with mediastinal downstaging have a significantly better survival than nonresponders. Restaging of the mediastinum is at the moment far from accurate. In case of locally advanced tumour (cT4), new surgical techniques and approaches make resection of carina, vena cava superior, vertebrae feasible with acceptable morbidity and mortality but additional studies are required. Conclusions Surgery remains the treatment of choice for curative treatment of NSCLC. The evolution of surgical techniques and the use of multimodality treatment further improve the results of surgical management. Rigorous patient selection, meticulous surgical technique and adequate peri- and postoperative management can keep operative morbidity and morbidity acceptable.