Surgical Therapy for Non-small Cell Lung Cancer in Japan - Abstract
Despite recent advances in surgical and multimodality treatments, lung cancer is still the leading cause of death due to malignant disease worldwide. In Japan, the number of surgical procedures for lung cancer has been steadily increasing (31,303 in 2009; 32,801 in 2010), totaling 33,878 in 2011. Lobectomy is a standard operating procedure commonly performed worldwide, which is recommended as the first choice of treatment for operable patients with clinical stage I or II non-small cell lung cancer. The proportion of Video-Assisted Thoracic Surgery (VATS) procedures increasing from 59.6% in 2010 to 62.9% in 2011. However, the treatment of choice varies depending on the extent of N2 lymph node involvement. Adjuvant therapy is generally administered to improve these outcomes, although its long-term effectiveness has not yet been demonstrated in lung cancer patients. Accordingly, there are great expectations regarding the potential of induction therapy and neo-adjuvant therapy. Nevertheless, the increased risk associated with surgery following induction therapy is a concern, attributable to possible surgical complications, especially after combined chemo-radiation therapy, and surgery-related death. Therefore, accurate mediastinal lymph node staging is one of the most important factors that can affect the patient outcome, as it not only determines the prognosis but also dictates the most suitable treatment strategy. We report on the status of surgical therapy and postoperative adjuvant chemotherapy for lung cancer patients in Japan. It is important to carefully select the most appropriate therapy on the basis of reliable evidence after considering the advantages as well as the potential therapeutic to improve the prognosis of each patient