Surgery for local and locally advanced non-small cell lung cancer.

Background: Surgical resection (usually lobectomy) is considered the treatment of choice for many individuals with early stage non-small cell lung cancer (NSCLC). However much of the evidence is observational. Objective(s): To determine whether, in patients with early stage NSCLC, surgical resection of cancer improves disease-specific and all-cause mortality compared with no treatment, radiotherapy or chemotherapy. Search Method(s): For this update we ran a new search in October 2009, using the following search strategy designed in the original review: Cochrane Central Register of Controlled Trials (CENTRAL) (accessed through The Cochrane Library, 2009, Issue 3), MEDLINE (accessed through PubMed), and EMBASE (accessed through Ovid). Selection Criteria: Randomised controlled trials comparing surgery alone (or in combination with other therapy) with non-surgical therapy and randomised trials comparing different surgical approaches. Data Collection and Analysis: A pooled hazard ratio was calculated where possible. Tests for statistical heterogeneity were performed. Main Result(s): Thirteen trials were included with a total of 2290 patients. Some of the included studies were judged as having a high risk of bias. There were no studies with an untreated control group. In a pooled analysis of three trials, overall survival was superior in patients with resectable stage I to IIIA NSCLC who underwent resection and complete mediastinal lymph node dissection compared with those undergoing resection and lymph node sampling (hazard ratio 0.63, 95% CI 0.51 to 0.78, P <= 0.0001) and there was no statistically significant heterogeneity. A further trial found an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small trial found a survival advantage in favour of chemotherapy followed by surgery compared to chemotherapy followed by radiotherapy in patients with stage IIIA NSCLC. However none of the other tria