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.