Place de la chirurgie dans le traitement des cancers localement avancés

Surgery is the best chance for cure of primary lung cancer. This treatment is limited to patients fit for a radical en-bloc extended resection. Surgical techniques such as cardiocirculatory bypass, osteosynthesis or prosthesis enable to plan for a radical resection of lung cancer and its nearby extension to thoracic organs in patients with high T-low N disease. We discuss the risk-benefit rationale of the different surgical options defined by extension. Surgery for N2 disease is still debated; while some authors strongly recommend to limit surgery to patients whose N-stage has been downstaged by induction therapy, there are arguments in favour of routine resection in all operable patients. Pneumonectomy can be justified in carefully selected patients, even after induction therapy.