Key Points

• Surgical resection remains an important part of treatment for select patients with locally advanced lung cancer
• Mediastinal staging is required prior to offering an extended pulmonary resection
• New technology such as 3D & 5D printing, intravascular ultrasound, gated MRI scanning, and endobronchial ultrasound allow for more precise pre-operative planning and allow surgeons to do more complex resections with risk stratification
• Extended pulmonary resection can be offered to patients who have N0 or N1 disease, in whom the surgeon can achieve a complete (R0) resection

Lung cancer is the most frequent cause of cancer death in both men and women. Lung cancers invade the chest wall in 5-10% of cases.[1],[2] Between 1% and 2% invade the vertebral bodies, diaphragm, pericardium, esophagus, or superior vena cava.[3] Complete surgical resection remains a key part of the multidisciplinary treatment for locally advanced lung cancer. When invasion of lung cancer extends beyond the visceral pleura, the ability to resect contiguous invading structures or organs varies greatly, and this role of surgery for locally advanced lung tumors (where there is direct invasion of the chest wall, vertebral bodies, diaphragm, aorta, left atrium, pericardium, esophagus, or superior vena cava) remains controversial. A patient’s prognosis after surgery is directly related to the completeness of the resection and the presence of nodal metastases. In this chapter, we will discuss advancements in surgery that allow resection of lung cancer with invasion beyond the pleura.

Figure 1

Surgical Incisions used for extended pulmonary resections: (A) Dartevelle transclavicular incision, (B) hemi-clamshell, (C) Masoka trans-sternal, (D) Shaw Paulson posterior lateral thoracotomy, (E) VATS ports.