Surgical Treatment of Lung Cancer Involving the Neighboring Structures

Yokoi Kohei

doi:10.2482/haigan.46.91

In the majority of patients lung cancer are only detected at advanced stages, they are mostly treated with chemotherapy or radiotherapy, or both, and the prognoses are usually poor. At present surgical resection is the only reliable curative method for the treatment of patients with lung cancer, and combined resection of the primary tumor and involved neighboring structures is performed when possible in patients with locally advanced disease. Tumors with direct extrapulmonary extension have been subdivided on the basis of the anatomic extent of disease and its potential for surgical treatment in the TNM classification for lung cancer: T3 lesions with limited, circumscribed extrapulmonary extension are considered potentially surgically resectable, whereas T4 tumors with extensive extrapulmonary extension are considered unresectable. Although surgical treatment for T3 lesions is generally accepted, the outcome is frequently not satisfactory. On the other hand, advanced surgical techniques are now being applied for T4 lesions due to the improvement of surgery and anesthesiology and progress in combined treatment modalities. This article reviews the results of surgical therapy for patients with lung cancer invading neighboring structures, including chest wall, superior sulcus, diaphragm, tracheal carina, left atrium, superior vena cava, aorta, and vertebrae. Furthermore, the surgical treatment of carcinomatous pleuritis is also assessed, and the role and future direction of surgical resection for locally advanced lung cancer is discussed.<br>

Surgical Treatment of Lung Cancer Involving the Neighboring Structures

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