Updated February 2008
Approximately one third of NSCLC patients have clinically operable disease.
Guideline: For patients with clinically operable NSCLC, surgical resection is the treatment with the best potential for cure.
Level of Evidence: III
Grade of Recommendation: B
The development of consistent criteria for resectability has proven elusive, as the assessment is influenced by surgical judgement. Patients with stage I or II NSCLC are routinely resected. However, only selected patients with stage IIIA, disease are resectable, especially those with T3N0M0 disease; patients with bulky N2 disease are generally not resectable. Almost all patients with stages IIIB and IV disease are unresectable. Exceptions would include highly selected patients with T4 disease (e.g., those found with limited invasion of the vertebral body, carina, great vessels, esophagus, or atrium; a satellite lesion in the same lobe) but without N2-3 disease. Rarely, a carefully selected patient with a solitary brain metastasis and a stage I to II primary lung tumor will be considered for resection. Patients with malignant pleural effusions are unresectable and are not appropriate candidates for curative treatment.