Surgical therapy of early non-small cell lung cancer

Approximately 45% of all lung carcinomas are limited to the lest, where sur gical resection is not only an important therapeutic modality but in many c ases, the most effective method of controlling the disease. Patients with T 1N0 and T2N0 tumors have early lung cancer, and most are curable by resecti on, with 5-year survival rates in the range of 75 to 80% for patients with T1N0 status. Patients with smaller tumors do better than patients with larg er ones, while visceral pleural invasion does not seem to influence surviva l, Histologic type is also a significant prognostic variable, with squamous tumors having a better prognosis than tumors of nonsquamous histology. Oth er known prognostic factors are age and gender of the patient and completen ess of resection, The "gold standard" of surgery remains lobectomy, regardl ess of tumor size at presentation. Stage T1N1 and T2N1 carcinomas represent a group of patients where the disease involves hilar and bronchopulmonary nodes. This group is best treated by complete resection with mediastinal ly mphadenectomy. Tumor size and histology are significant prognostic variable s, and 5-year survival after complete resection is in the range of 40 to 50 %. Postoperative radiation therapy may improve local control, while chemoth erapy results in a slightly reduced risk of death.