Surgical treatment of non-small-cell lung cancer

摘要

abstract_textpThe prognosis of non-small-cell lung cancer (NSCLC) is poor. The overall 5-year survival has not changed over the past decades and is still in the range of 15 despite significant advances in systemic and radiation therapy. Surgery is the treatment modality of choice and should be considered first in every patient who presents with stage I or II cancer in the absence of functional contraindications. Radical resection remains the prime goal of the operation. Standard procedures include lobectomy, bilobectomy and pneumonectomy. By using bronchoplastic techniques pneumonectomy can be avoided in many cases. Mortality after pneumonectomy ranges between 3-10 and after lobectomy around 2. Limited resection is appropriate in high risk patients or in candidates with poor pulmonary function. In stage IIIA and IIIB cancer non-operative therapy is usually indicated, ideally as part of a clinical trial. In selected patients, however, surgery can follow as an adjunct therapy. Treatment modalities in stage IIIA cancer remain controversial. Surgery in stage IV lung cancer remains the exception, e.g. for palliative reasons or in selected patients with solitary brain or suprarenal metastases. Factors which dominate survival are completeness of resection and tumor stage./p/abstract_text