Controversies in the surgical treatment of non-small cell lung cancer

Lung cancer continues to be one of the most frequent cancer-related causes of death worldwide. Despite the general acknowledgment that surgical resection is the most effective treatment in non-small cell lung cancer, there remains significant areas of controversy in the application of surgical resection. Appropriate patient selection must be based on the assessment of benefits and risks involved for the patient. This decision, however, is multifactorial and approached differently by surgeons worldwide based on a combination of training, clinical practice experience and available research data. Efficacy of competing non-invasive and invasive mediastinal staging modalities, the extent of mediastinal staging and surgical resection, as well as whether there is a role for surgery in locally advanced or metastatic lung cancer are further controversial topics addressed in this review.