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Ann Thorac Surg 1992;54:999-1013
© 1992 The Society of Thoracic Surgeons

Articles

Surgical treatment for higher stage non-small cell lung cancer

Dirk E. Van Raemdonck, MDa,b,c, Airton Schneider, MDa,b,c, Robert J. Ginsberg, MD*,a,b,c

a Sloan-Kettering Institute, Cornell University Medical College, New York, New York, USA
b Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York, USA
c Department of Surgery, Cornell University Medical College, New York, New York, USA

* Address reprint requests to Dr Ginsberg, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Cencer, 1275 York Ave, New York, NY 10021.

Locally advanced lung cancer (stage IIIa, IIIb) in which the primary tumor is proximal (T3) or has invaded adjacent structures (T3) or organs (T4) or in which mediastinal lymph nodes are involved (N2, N3) worsens the prognosis significantly. However, in stage IIIa (T3 or N2), when surgical treatment results in total removal of the primary tumor and involved lymph nodes, there still is a reasonable chance for ultimate cure. On the other hand, total excision can be very rarely performed in T4 or N3 tumors. Therefore, this group (stage IIIb) usually indicates unresectability. Disseminated lung cancer with distant metastasis (stage IV) is still considered to be incurable. Nevertheless, solitary metastatic sites (M1), especially brain, have been treated on occasion by resection of the primary tumor and removal of the solitary metastasis. This appears to improve median survival and does yield 5-year survival in selected patients. The results after surgical treatment in these patients with higher stage lung cancer reported over the last 10 years are reviewed.




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