Semin Respir Crit Care Med 2011; 32(1): 069-077
DOI: 10.1055/s-0031-1272871
© Thieme Medical Publishers

Surgical Management of Lung Cancer

Sandra C. Tomaszek1 , Dennis A. Wigle1
  • 1Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
Further Information

Publication History

Publication Date:
15 April 2011 (online)

ABSTRACT

Lung cancer continues to be the most frequent cancer-related cause of death in the United States and throughout the world. Surgical resection is currently the most effective treatment in early-stage non-small-cell lung cancer, and historically the only treatment approach achieving significant cure rates. In advanced disease, therapeutic approaches involving chemotherapy and/or radiation therapy are utilized to improve prognosis, either as part of a neoadjuvant treatment approach followed by surgical resection or as definitive treatment alone. The role of surgery in locally advanced or metastatic non-small-cell lung cancer remains controversial, with more studies required to further refine the application of modern surgical techniques. For any treatment approach, thorough preoperative staging as well as careful patient selection are essential to assess the benefits and risks involved for the patient. Surgical management of early-stage non-small-cell lung cancer and its role in more advanced disease are discussed in this review.

REFERENCES

  • 1 National Cancer Institute .Surveillance, Epidemiology and End Results (SEER). http://seer.cancer.gov Accessed July 28, 2010
  • 2 Chansky K, Sculier J P, Crowley J J, Giroux D, Van Meerbeeck J, Goldstraw P. International Staging Committee and Participating Institutions . The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer.  J Thorac Oncol. 2009;  4 (7) 792-801
  • 3 Goldstraw P, Crowley J, Chansky K International Association for the Study of Lung Cancer International Staging Committee et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours.  J Thorac Oncol. 2007;  2 (8) 706-714
  • 4 Maziak D E, Darling G E, Inculet R I et al.. Positron emission tomography in staging early lung cancer: a randomized trial.  Ann Intern Med. 2009;  151 (4) 221-228, W-48
  • 5 Fischer B, Lassen U, Mortensen J et al.. Preoperative staging of lung cancer with combined PET-CT.  N Engl J Med. 2009;  361 (1) 32-39
  • 6 Medford A R, Bennett J A, Free C M, Agrawal S. Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy.  Curr Opin Pulm Med. 2009;  15 (4) 334-342
  • 7 Berry M F, Hanna J, Tong B C et al.. Risk factors for morbidity after lobectomy for lung cancer in elderly patients.  Ann Thorac Surg. 2009;  88 (4) 1093-1099
  • 8 Voltolini L, Rapicetta C, Ligabue T, Luzzi L, Scala V, Gotti G. Short- and long-term results of lung resection for cancer in octogenarians.  Asian Cardiovasc Thorac Ann. 2009;  17 (2) 147-152
  • 9 Goodgame B, Viswanathan A, Zoole J et al.. Risk of recurrence of resected stage I non-small cell lung cancer in elderly patients as compared with younger patients.  J Thorac Oncol. 2009;  4 (11) 1370-1374
  • 10 Ferguson M K, Parma C M, Celauro A D, Vigneswaran W T. Quality of life and mood in older patients after major lung resection.  Ann Thorac Surg. 2009;  87 (4) 1007-1012 discussion 1012-1013
  • 11 Schulte T, Schniewind B, Walter J, Dohrmann P, Küchler T, Kurdow R. Age-related impairment of quality of life after lung resection for non-small cell lung cancer.  Lung Cancer. 2010;  68 (1) 115-120
  • 12 Subotic D R, Mandaric D V, Eminovic T M et al.. Influence of chronic obstructive pulmonary disease on postoperative lung function and complications in patients undergoing operations for primary non-small cell lung cancer.  J Thorac Cardiovasc Surg. 2007;  134 (5) 1292-1299
  • 13 Tomaszek S C, Cassivi S D, Shen K R et al.. Clinical outcomes of video-assisted thoracoscopic lobectomy.  Mayo Clin Proc. 2009;  84 (6) 509-513
  • 14 Okami J, Higashiyama M, Asamura H Japanese Joint Committee of Lung Cancer Registry et al. Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer: prognostic factors for overall survival and risk factors for postoperative complications.  J Thorac Oncol. 2009;  4 (10) 1247-1253
  • 15 Ginsberg R J, Rubinstein L V. Lung Cancer Study Group . Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer.  Ann Thorac Surg. 1995;  60 (3) 615-622 discussion 622-623
  • 16 Kilic A, Schuchert M J, Pettiford B L et al.. Anatomic segmentectomy for stage I non-small cell lung cancer in the elderly.  Ann Thorac Surg. 2009;  87 (6) 1662-1666 discussion 1667-1668
  • 17 Martin-Ucar A E, Nakas A, Pilling J E, West K J, Waller D A. A case-matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients.  Eur J Cardiothorac Surg. 2005;  27 (4) 675-679
  • 18 Pettiford B L, Schuchert M J, Santos R, Landreneau R J. Role of sublobar resection (segmentectomy and wedge resection) in the surgical management of non-small cell lung cancer.  Thorac Surg Clin. 2007;  17 (2) 175-190
  • 19 Schuchert M J, Pettiford B L, Keeley S et al.. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer.  Ann Thorac Surg. 2007;  84 (3) 926-932 discussion 932-933
  • 20 Ferguson M K, Little A G, Golomb H M et al.. The role of adjuvant therapy after resection of T1 N1 M0 and T2 N1 M0 non-small cell lung cancer.  J Thorac Cardiovasc Surg. 1986;  91 (3) 344-349
  • 21 Marra A, Hillejan L, Zaboura G, Fujimoto T, Greschuchna D, Stamatis G. Pathologic N1 non-small cell lung cancer: correlation between pattern of lymphatic spread and prognosis.  J Thorac Cardiovasc Surg. 2003;  125 (3) 543-553
  • 22 Jang R W, Le Maître A, Ding K et al.. Quality-adjusted time without symptoms or toxicity analysis of adjuvant chemotherapy in non-small-cell lung cancer: an analysis of the National Cancer Institute of Canada Clinical Trials Group JBR.10 trial.  J Clin Oncol. 2009;  27 (26) 4268-4273
  • 23 Landreneau R J, Hazelrigg S R, Mack M J et al.. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy.  Ann Thorac Surg. 1993;  56 (6) 1285-1289
  • 24 McKenna Jr R J, Mahtabifard A, Pickens A, Kusuanco D, Fuller C B. Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy.  Ann Thorac Surg. 2007;  84 (5) 1663-1667 discussion 1667-1668
  • 25 Flores R M, Park B J, Dycoco J et al.. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer.  J Thorac Cardiovasc Surg. 2009;  138 (1) 11-18
  • 26 Scott W J, Allen M S, Darling G et al.. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial.  J Thorac Cardiovasc Surg. 2010;  139 (4) 976-981 discussion 981-983
  • 27 Nicastri D G, Wisnivesky J P, Litle V R et al.. Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance.  J Thorac Cardiovasc Surg. 2008;  135 (3) 642-647
  • 28 Petersen R P, Pham D, Burfeind W R et al.. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer.  Ann Thorac Surg. 2007;  83 (4) 1245-1249, discussion 1250
  • 29 Kirby T J, Mack M J, Landreneau R J, Rice T W. Lobectomy—video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial.  J Thorac Cardiovasc Surg. 1995;  109 (5) 997-1001 discussion 1001-1002
  • 30 McKenna Jr R J, Houck W, Fuller C B. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases.  Ann Thorac Surg. 2006;  81 (2) 421-425 discussion 425-426
  • 31 Solaini L, Prusciano F, Bagioni P, Poddie D B. Long-term results of video-assisted thoracic surgery lobectomy for stage I non-small cell lung cancer: a single-centre study of 104 cases.  Interact Cardiovasc Thorac Surg. 2004;  3 (1) 57-62
  • 32 Solaini L, Prusciano F, Bagioni P, di Francesco F, Solaini L, Poddie D B. Video-assisted thoracic surgery (VATS) of the lung: analysis of intraoperative and postoperative complications over 15 years and review of the literature.  Surg Endosc. 2008;  22 (2) 298-310
  • 33 Giudicelli R, Thomas P, Lonjon T et al.. Major pulmonary resection by video assisted mini-thoracotomy. Initial experience in 35 patients.  Eur J Cardiothorac Surg. 1994;  8 (5) 254-258
  • 34 Swanson S J, Herndon II J E, D'Amico T A et al.. Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study.  J Clin Oncol. 2007;  25 (31) 4993-4997
  • 35 Belgers E H, Siebenga J, Bosch A M, van Haren E H, Bollen E C. Complete video-assisted thoracoscopic surgery lobectomy and its learning curve. A single center study introducing the technique in The Netherlands.  Interact Cardiovasc Thorac Surg. 2010;  10 (2) 176-180
  • 36 Seder C W, Hanna K, Lucia V et al.. The safe transition from open to thoracoscopic lobectomy: a 5-year experience.  Ann Thorac Surg. 2009;  88 (1) 216-225 discussion 225-226
  • 37 Reed M F, Lucia M W, Starnes S L, Merrill W H, Howington J A. Thoracoscopic lobectomy: introduction of a new technique into a thoracic surgery training program.  J Thorac Cardiovasc Surg. 2008;  136 (2) 376-381
  • 38 Ferguson J, Walker W. Developing a VATS lobectomy programme—can VATS lobectomy be taught?.  Eur J Cardiothorac Surg. 2006;  29 (5) 806-809
  • 39 Gopaldas R R, Bakaeen F G, Dao T K, Walsh G L, Swisher S G, Chu D. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients.  Ann Thorac Surg. 2010;  89 (5) 1563-1570
  • 40 Paul S, Altorki N K, Sheng S et al.. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database.  J Thorac Cardiovasc Surg. 2010;  139 (2) 366-378
  • 41 Mun M, Kohno T. Video-assisted thoracic surgery for clinical stage I lung cancer in octogenarians.  Ann Thorac Surg. 2008;  85 (2) 406-411
  • 42 Cattaneo S M, Park B J, Wilton A S et al.. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications.  Ann Thorac Surg. 2008;  85 (1) 231-235 discussion 235-236
  • 43 Demmy T L, Nwogu C. Is video-assisted thoracic surgery lobectomy better? Quality of life considerations.  Ann Thorac Surg. 2008;  85 (2) S719-S728
  • 44 Shaw J P, Dembitzer F R, Wisnivesky J P et al.. Video-assisted thoracoscopic lobectomy: state of the art and future directions.  Ann Thorac Surg. 2008;  85 (2) S705-S709
  • 45 Watanabe A, Ohori S, Nakashima S et al.. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas.  Eur J Cardiothorac Surg. 2009;  35 (5) 775-780, discussion 780
  • 46 Scott W J, Howington J, Feigenberg S, Movsas B, Pisters K. American College of Chest Physicians . Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;  132 (3, Suppl) 234S-242S
  • 47 Park B J, Flores R M, Rusch V W. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results.  J Thorac Cardiovasc Surg. 2006;  131 (1) 54-59
  • 48 Gharagozloo F, Margolis M, Tempesta B, Strother E, Najam F. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases.  Ann Thorac Surg. 2009;  88 (2) 380-384
  • 49 Furuse K, Fukuoka M, Kawahara M et al.. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer.  J Clin Oncol. 1999;  17 (9) 2692-2699
  • 50 Fournel P, Robinet G, Thomas P Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie NPC 95-01 Study.  J Clin Oncol. 2005;  23 (25) 5910-5917
  • 51 Byhardt R W, Scott C, Sause W T et al.. Response, toxicity, failure patterns, and survival in five Radiation Therapy Oncology Group (RTOG) trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non-small-cell carcinoma of the lung.  Int J Radiat Oncol Biol Phys. 1998;  42 (3) 469-478
  • 52 Albain K S, Swann R S, Rusch V W et al.. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial.  Lancet. 2009;  374 (9687) 379-386
  • 53 Stinchcombe T E, Bogart J, Wigle D A, Govindan R. Annual review of advances in lung cancer clinical research: a report for the year 2009.  J Thorac Oncol. 2010;  5 (7) 935-939
  • 54 Edelman M J, Suntharalingam M, Burrows W et al.. Phase I/II trial of hyperfractionated radiation and chemotherapy followed by surgery in stage III lung cancer.  Ann Thorac Surg. 2008;  86 (3) 903-910
  • 55 Cerfolio R J, Maniscalco L, Bryant A S. The treatment of patients with stage IIIA non-small cell lung cancer from N2 disease: who returns to the surgical arena and who survives.  Ann Thorac Surg. 2008;  86 (3) 912-920 discussion 912-920
  • 56 Caglar H B, Baldini E H, Othus M et al.. Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery.  Cancer. 2009;  115 (18) 4156-4166
  • 57 Meyers B F, Haddad F, Siegel B A et al.. Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer.  J Thorac Cardiovasc Surg. 2006;  131 (4) 822-829 discussion 822-829
  • 58 Defranchi S A, Cassivi S D, Nichols F C et al.. N2 disease in T1 non-small cell lung cancer.  Ann Thorac Surg. 2009;  88 (3) 924-928
  • 59 Veeramachaneni N K, Battafarano R J, Meyers B F, Zoole J B, Patterson G A. Risk factors for occult nodal metastasis in clinical T1N0 lung cancer: a negative impact on survival.  Eur J Cardiothorac Surg. 2008;  33 (3) 466-469
  • 60 Al-Sarraf N, Aziz R, Gately K et al.. Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography.  Eur J Cardiothorac Surg. 2008;  33 (1) 104-109
  • 61 Carnochan F M, Walker W S. Positron emission tomography may underestimate the extent of thoracic disease in lung cancer patients.  Eur J Cardiothorac Surg. 2009;  35 (5) 781-784 discussion 784-785
  • 62 Lee P C, Port J L, Korst R J, Liss Y, Meherally D N, Altorki N K. Risk factors for occult mediastinal metastases in clinical stage I non-small cell lung cancer.  Ann Thorac Surg. 2007;  84 (1) 177-181
  • 63 Gajra A, Newman N, Gamble G P, Abraham N Z, Kohman L J, Graziano S L. Impact of tumor size on survival in stage IA non-small cell lung cancer: a case for subdividing stage IA disease.  Lung Cancer. 2003;  42 (1) 51-57
  • 64 Rusch V W, Albain K S, Crowley J J et al.. Surgical resection of stage IIIA and stage IIIB non-small-cell lung cancer after concurrent induction chemoradiotherapy. A Southwest Oncology Group trial.  J Thorac Cardiovasc Surg. 1993;  105 (1) 97-104 discussion 104-106
  • 65 Oh Y, Taylor S, Bekele B N et al.. Number of metastatic sites is a strong predictor of survival in patients with nonsmall cell lung cancer with or without brain metastases.  Cancer. 2009;  115 (13) 2930-2938
  • 66 Baschnagel A, Wolters P L, Camphausen K. Neuropsychological testing and biomarkers in the management of brain metastases.  Radiat Oncol. 2008;  3 26
  • 67 Bindal A K, Bindal R K, Hess K R et al.. Surgery versus radiosurgery in the treatment of brain metastasis.  J Neurosurg. 1996;  84 (5) 748-754
  • 68 Louie A V, Rodrigues G, Yaremko B et al.. Management and prognosis in synchronous solitary resected brain metastasis from non-small-cell lung cancer.  Clin Lung Cancer. 2009;  10 (3) 174-179
  • 69 Mercier O, Fadel E, Mussot S et al.. Is surgery required for patients with isolated adrenal metastasis of non-small cell lung carcinoma?.  [in French] Presse Med. 2007;  36 (12 Pt 1) 1743-1752
  • 70 Tanvetyanon T, Robinson L A, Schell M J et al.. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis.  J Clin Oncol. 2008;  26 (7) 1142-1147

Dennis A WigleM.D. Ph.D. 

Division of General Thoracic Surgery, Mayo Clinic

200 First St. SW, Rochester, MN 55905

Email: wigle.dennis@mayo.edu

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