Surgical considerations in lung cancer treatment

Surgery is fundamental to curative treatment of lung cancer. Resectability is determined by patient fitness to undergo surgery and tumor characteristics. Appropriate tumor staging, especially mediastinal nodal involvement, is a critical aspect of surgical planning. Pulmonary function testing must be performed to determine whether a patient can tolerate loss of lung parenchyma safely. Stage I/II disease is treated definitively with lobectomy, with adjuvant chemotherapy for select patient groups, and sublobar resection is reserved for patients with high morbidities or low-risk tumors. Stage III disease has heterogeneous presentation, and careful evaluation must be performed to determine which patients will receive oncologic benefit from surgical intervention.