LUNG-CANCER SURGERY - A CRITICAL-REVIEW OF THE EVIDENCE

Surgery is generally considered to be the treatment of choice for anat omically localized non-small-cell lung cancer, but its effectiveness r emains unproven. Observational studies have been of limited value beca use the criteria by which patients are selected for surgery create sub stantial differences between patients who undergo surgery and those wh o do not. One small randomized trial of surgery vs radiotherapy was in conclusive, but several large trials of lung cancer screening have pro vided indirect evidence against a benefit from surgery. Two ongoing ra ndomized trials, one on extensive vs limited resection and the other o n the effect of surgery in more extensive disease, may provide further insight into the effectiveness of surgery in the treatment of localiz ed non-small-cell lung cancer. Development of a large randomized trial to directly assess the effectiveness of surgery in the treatment of l ocalized non-small-cell lung cancer has been precluded by ethical conc erns, but may need to be reconsidered if indicated by the findings of the two ongoing studies.