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Review
. 2014 May;6 Suppl 2(Suppl 2):S217-23.
doi: 10.3978/j.issn.2072-1439.2014.04.34.

Surgical management of advanced non-small cell lung cancer

Gonzalo Varela  1 , Pascal Alexandre Thomas  1
Affiliations
Review

Surgical management of advanced non-small cell lung cancer

Gonzalo Varela et al. J Thorac Dis. 2014 May.

Abstract

More than 75% of the cases of non-small cell lung cancer (NSCLC) are diagnosed in advanced stages (IIIA-IV). Although in these patients the role of surgery is unclear, complete tumor resection can be achieved in selected cases, with good long-term survival. In this review, current indications for surgery in advanced NSCLC are discussed. In stage IIIA (N2), surgery after induction chemotherapy seems to be the best option. The indication of induction chemotherapy plus radiotherapy is debatable due to potential postoperative complications but recently reported experiences have not shown a higher postoperative risk in patients after chemo and radiotherapy induction even if pneumonectomy is performed. In cases of unexpected N2 found during thoracotomy, lobectomy plus systematic nodal dissection is recommended mostly for patients with single station disease. In stage IIIB, surgery is only the choice for resectable T4N0-1 cases and should not be indicated in cases of N2 disease. Favorable outcomes are reported after extended resections to the spine and mediastinal structures. Thorough and individualized discussion of each stage IIIB case is encouraged in the context of a multidisciplinary team. For stage IV oligometastatic cases, surgery can still be included when planning multimodality treatment. Brain and adrenal gland are the two most common sites of oligometastases considered for local ablative therapy.

Keywords: Non-small cell lung cancer (NSCLC); extended pulmonary resection; multimodality treatment; surgical therapy.

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Figures

Figure 1
Figure 1
Squamous cell carcinoma of the left upper lobe with large lymph node metastasis in the prevascular area. This case could be considered for induction treatment and further re-assessment for surgery.
Figure 2
Figure 2
T4N2 adenocarcinoma invading the spine. Due to mediastinal spread to the 4R region, salvage surgery is not the choice in this case.
See this image and copyright information in PMC

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