Advances in surgical treatment of lung cancer

In 1933, Graham successfully performed simple pneumonectomy for lung cancer. Since then, there has been great progress in surgical procedures such as anatomical lung resection, radical lung resection, combined resection of adjacent organs, bronchoplastic surgery and extensive lymph node dissection. Surgical mortality was over 20% in the early years. However, it has currently decreased to a few percent. According to a multi-institutional data analyzed by Ginsberg (1983), the modern 30-day surgical mortality is 3.7% overall (6.2% for pneumonectomy and 2.9% for lobectomy). The long-term survival rate for resected lung cancer patients has improved remarkably in recent years. The reported five-year survival rates of stage I non small cell cancer range between 60% and 85%, and those of stage II cancer range between 20% and 40%. Among stage IIIA cases, the optimal surgical outcome was shown in the group undergoing chest wall resection for T3N0M0 disease. However, the results of N2 disease generally show a poor surgical outcome. Therefore, trials of induction therapy are being done at many institutes. The surgical results of bronchoplastic surgery have markedly improved in recent years, especially among the group undergoing sleeve lobectomy. Stage I small cell carcinoma shows excellent surgical result with the aid of pre-or postoperative adjuvant chemotherapy with or without radiotherapy.