Analyzing the Surgical Resection of Lung Cancer

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The public health significance of lung cancer is reflected by the fact that this disease is one of the most common cancers in the world and it has a high case fatality rate. In the span of a few decades, lung cancer has gone from being a rare disease to the most common cancer worldwide and the greatest cause of cancer death globally. In 2008, lung cancer accounted for 13% (1.6 million) of the total cases and 18% (1.4 million) of the deaths, worldwide. Non-Small Cell Lung Cancer (NSCLC) comprises 80% of all cases. Mortality form lung cancer basically occurs through the metastatic spread of malignant cells to distant organs.

It is estimated that only 10% of new cases of bronchogenic carcinoma are potentially cured by surgery. Surgery is the treatment of choice for patients with stage I-II disease and selected patients with stage IIIA disease. Compared with radiotherapy in early stage disease, surgical treatment is the best alternative. In European countries the proportion of patients with diagnosed lung cancer who undergo surgery for lung cancer varies between 10 and 20% [5,6]. In the UK the resection rates in some areas are around 10%, but with quick access investigations the rate can easily be increased to 25%. In the United States it is estimated that approximately 25-30% of patients with NSCLC are offered surgery with curative intent.

Surgery for tuberculosis formed the basis for lung cancer surgery techniques, but after theintroduction of potent drugs for tuberculosis in the 1950’s, lung cancer surgery became themajor focus in chest surgery. The first successful pneumonectomy was performed in1933 by Drs. Graham and Singer in the USA. The rate of complications was high duringthe first years, with a reported early mortality of 30% in 1944. The rate of explorative thoracotomy without resection was also high (50%), by 1940 lobectomy andpneumonectomy were performed regularly for NSCLC with remarkable progress in early surgical results. During the next decades, radical pneumonectomy remained the golden standard, with a relatively low operative mortality, to be replaced in the 1960s by lobectomy as the standard in localized disease, resulting in a better surgical outcome and greater pulmonary reserve.