According to Interactive Cardio Vascurare and Thoracic Surgery (July 2010), surgical treatment remains the best treatment for patients with locally advanced lung cancer such as T4N0 and T4N1. Stage T4 lung cancer is defined as tumor invasion of large blood vessels, heart, bulge, spine, chest wall and other organs, and the stage is usually late. Previously, surgical resection for T4 lung cancer patients was usually more difficult and surgical treatment was not recommended. However, for patients with T4N0 as well as T4N1 stage lung cancer, are there any surgical opportunities? Does surgery still have positive implications? Professor Anthony Chambers from Brighton and Sussex Medical School in the UK has provided a very convincing answer to these questions through a systematic approach. The research team searched the literature and extracted data for a more detailed analysis. They concluded that preemptive surgery in carefully selected patients with stage T4 lung cancer without mediastinal lymph node invasion (T4N0 and T4N1 non-small cell lung cancer) is beneficial for improved survival, and also found significant differences in prognosis for tumor invasion of different major organ structures. For example, invasion of the pulmonary artery (5-year survival rate 52.8%) had a better prognosis compared to invasion of other mediastinal structures (left atrium, superior vena cava, aorta, bulge, and esophagus). In addition, the investigators found that the most decisive factors affecting prognosis were the completeness of resection and the patient’s N stage, respectively. One study reported that the survival rate of patients with invasion of large pulmonary vessels alone is much higher than that of patients with other T4 stage lung cancers. Multiple intralobar lesions including multiple intralobar metastases and multiple primary non-small cell lung cancers have a different biological behavior than invasive stage T4 lung cancers, and the 5-year survival rate of non-small cell lung cancers with satellite nodes has been reported to be 48,2%-57%, confirming that ipsilateral multiple nodal stage T4 lesions in TNM staging should be changed to stage T3. Although it has been suggested that patients with localized invasion of major structures have a poorer prognosis, studies have consistently shown that patients with T4N0 and T4N1 lung cancer have better survival rates when first treated surgically, and surgical treatment is recommended for these patients.