Role of Surgery in Treatment of Lung Cancer

In spite of developments in all aspects of treatment of lung cancer, surgery is still the most effective treatment provided that the tumor could be resected completely. Although radiotherapy with or without chemotherapy effective in palliation or occasionally in curative treatment of lung cancer, it is less effective than surgery. Chemotherapy as a primary treatment is indicated only for palliation of advanced disease. Unfortunately only small numbers of patients are good candidates for surgical treatment. The goal of the surgical resection is to cure the patients, however, it is used occasionally just for palliation of symptoms such as hemoptysis, infection or intractable effusions. These symptoms could also be palliated with less invasive methods like laser therapy or radiation therapy. Most of the surgical procedures are lobectomy and pneumonectomy, sampling or complete resection of mediastinal lymph nodes which is an obligatory part of the surgery. More complex procedures like sleeve pneumonectomy and resection-reconstruction of the chest wall are used in some patients. Non anatomic resections like wedge resection are not standard forms of resection as they frequently result in a local recurrence, therefore, thoracoscopy is also not widely used for resection of lung cancer.Surgical resection is usually the only primary treatment for stage I & II, although some advise chemotherapy with surgery even at these stages. For stage IIIA, adjuvant or neo-adjuvant treatments are commonly advised. For stage IIIB or IV surgery has been used very occasionally in the form of multimodality treatments, although the results are poor.