Chirurgische therapie des nichtkleinzelligen lungenkarzinoms. Stadium I/II

For every patient with locoregional circumscribed non-small cell lung cancer (NSCLC), consideration should be given to surgical management. The standard resection procedures for patients with sufficient functional reserve are lobectomy, extended lobectomy with bronchoplasty and/or angioplasty, bilobectomy, or pneumonectomy. Nonanatomic or atypical lung resections are only justified in exceptional cases for high-risk patients. Unaffected pulmonary lobes should be preserved and if necessary reanastomosed. There is no survival benefit gained by a resection that goes beyond radical removal of the macroscopically and microscopically visible tumor. Total ipsilateral lymph node dissection (interlobar, hilar, and mediastinal) completes every surgical treatment with curative intent. After the diagnosis of NSCLC has been made, the prognosis is poor. One year after the diagnosis 45% of the patients are alive, but after 5 years only 14% of the patients. If the subgroup of surgically cured patients with stage Ia disease is considered, the survival probabilities are 93% after 1 year and 70-80% after 5 years. In this respect, surgery for early stage NSCLC offers a well-founded prospect for cure. Additional adjuvant (postoperative) chemotherapy following complete resection (for patients with stage II NSCLC) can improve the survival probability by a further 4-15%. In general, the indication for or against surgery should result from careful interdisciplinary consultation that takes into account all factors of tumor extent and individual comorbidity. Inoperability should not solely be determined on the basis of expectations, but only by considering all of the individual patient factors.