If a consecutive series of patients with lung cancer is followed up
until the decision is made about therapy, it emerges that the role
of surgery is quite small. Only a very limited proportion will
ultimate ly qualify for rationally conceived surgical therapy; most
patients are inoperable. In a series of 397 patients investigated
at our hospi tal, 78% were inoperable on the basis of preoperative
evaluation and a further 3% proved nonresectable at thoracotomy;
therefore, only 19% were suitable for resection. On the other hand,
surgery is still thought to offer the best, if not the only
realistic chance of cure. The question "operable or not?" is
therefore of vital importance for the individual patient. The
answer to this crucial question must be based on valid guidelines
for pa tient selection and preoperative evaluation, and it should
be clearly defined what extent of resection is necessary in order
to realize any curative intention. In 1972 a thorough analysis of
the literature revealed that re section of bronchial carcinoma -
although 40 years old - was being undertaken with very variable
indications. There was hardly any systematic staging, and
assessment of results was hampered by the fact that most
communications in the literature were based on retrospective
analysis.
General
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