I. Surgical treatment of special lesions Small and peripheral lesions, also called nodal lesions, are often felt to be “more than worth the cost” by conventional surgery. For those who do not have extensive pleural adhesions, thoracoscopic surgery should be advocated, and subscopic lymph node dissection should be carried out. For nodal foci that are estimated to be difficult to reach intraoperatively, CT-guided percutaneous puncture should be performed before surgery, and dye should be injected around the foci, which can be rapidly localized and precisely excised intraoperatively based on the dye to avoid the adverse consequences of blindness. It can also be combined with CT-guided dye labeling and thoracoscopy to achieve a minimally invasive and accurate double effect. In addition to the dye, it is also possible to perform preoperative CT-guided percutaneous puncture of the lesion with a needle with a lateral hook, thus allowing fixation on the lesion, with a thread at the end of the needle as a marker and intraoperative resection of the sought lesion. Patients with uncharacterized lesions in both lungs often pose a dilemma to surgeons, as non-operative surgery is feared to delay treatment, and blind surgery is feared to be over-indicated (M1), both of which appear blind. For this reason, Japanese scholars perform bilateral thoracoscopy in the operating room, and if the biopsy confirms that both lung lesions are cancerous, further surgery is abandoned; if one lung is benign (non-metastatic), open-heart surgery on the other side (lung cancer) is performed immediately. This method can avoid unhelpful surgery and is in line with the principles of surgical treatment, which is worth learning. In cases of localized extranodal lung cancer, the depth of tissue invasion varies. The treatment effect (including local recurrence rate and survival rate) is related to the degree of tumor invasion, surgical method and other factors. In a group of 334 patients with lung cancer invading the chest wall, 175 of them had complete resection of the invaded tissue, 94 had incomplete resection, and 65 had dissection only, and the 5-year survival rates were 32%, 4%, and 0%, respectively. In addition, the 5-year survival rate was as high as 49% for N0, 27% for N1, and only 15% for N2 patients in this group. Lung cancer invades mediastinal organs more commonly (T3 or T4), and the invaded objects include left atrium, superior vena cava, trachea, thoracic aorta, thoracic vertebral body and esophagus. In terms of treatment, the 5-year survival rate is 18% for complete tumor resection and 0% for those with residual tumor; the 5-year survival rate is 36% for squamous carcinoma and 0% for other types; the 5-year survival rate reaches 36% for those with only N0 or N1 lymph node metastasis and 0% for N2 or N3. It is obvious that the surgical outcome of patients with lung cancer invading the mediastinum is directly related to the pathological type of tumor, the degree of lymph node metastasis, and the thoroughness of surgical resection. From the above, the effect of surgical treatment for lung cancer invasion is limited, but relatively complete resection of the lesion is still important to improve the survival rate. The most serious postoperative complication of lung cancer is bronchopleural fistula. Although the incidence is not high, it is very difficult to manage and the prognosis is very poor. As far as surgery is concerned, preventive measures should focus on the treatment of bronchial stumps. The stump should generally be less than 1 cm in length, the proximal end should be separated anteriorly and posteriorly from the bronchus to preserve its lateral bronchial artery, the sutures should be tied loosely and tightly to fit the bronchial wall closely, do not cut and tear, cover the stump with pleura if necessary, and avoid postoperative hypoxemia (necrosis) and pleural effusion (immersion). A review study from Geneva showed that the incidence of bronchopleural fistulae after total lung resection on one side was 3-9%, with tumors located in the main bronchus and postoperative ventilator use being more frequent, in addition to extensive mediastinal lymph node dissection being a factor. The incidence of bronchopleural fistulas has increased in recent years, probably due to the use of bronchoclips in the 1990s, and it is recommended that they be used with caution in total pneumonectomy for the main bronchus. Despite the differences in opinion, the key to fistula prevention remains the proper management of the stump. Bronchopleural fistulas after total lung resection are often combined with abscess chests, which are at high risk for surgical intervention, and drainage is often incomplete. In the past, the bronchopleural fistulas have been treated with the use of tracheoscopic or thoracoscopic exploration of the chest and drainage under direct visualization, supplemented by drip irrigation with antibiotic solution in appropriate locations, which can achieve better results. It has also been reported that direct stapling of bronchial stump fistulas using thoracoscopy, supplemented by free muscle flap coverage in some patients, can lead to the cure of most bronchopleural fistulas. It seems that minimally invasive means will become a very promising treatment method. New surgical methods and exploration Lung cancer surgery is routinely performed with a posterior lateral incision, which is more traumatic and more reactive than general surgery, but too small an incision affects surgical exposure and safety. In order to take into account both factors, some authors innovated a light-assisted anterior thoracic incision. The method is an anterolateral incision in the fourth intercostal space with a fiber-optic cold light source placed in the eighth intercostal space in the ipsilateral postaxillary line, which is said to provide good exposure and satisfactory illumination. All types of pneumonectomy can be performed with reduced postoperative blood loss and significantly less chest pain than with conventional incisions. For lesions invading the chest wall in the posterior upper chest, it is very difficult to remove part of the chest wall because of poor exposure due to the obstruction of the scapula. A good operative field can be obtained by separating the muscles with Kent’s retractor, pulling up the scapula with a hook suspension, and cutting off part of the dorsal shoulder muscles. Central type lung cancer invades the main bronchus, which is difficult to remove by general surgery, and anesthesia and oxygen supply are difficult, often leading to residual tumor or positive cut ends. For this reason, a median sternal incision is adopted to establish extracorporeal circulation with membrane lung to isolate the oxygen supply to the lung and blood supply to the pulmonary artery, so that whole lung resection and augmentation can be performed comfortably. With the development of tracheal surgery and anesthesia, many lung cancers invading the trachea and main bronchi can now be performed without extracorporeal circulation. However, these methods can still be used in some special cases. In recent years, the coronary surgery department has made great progress and can perform coronary artery bypass grafting under nonstop cardiac pulsation, which is generally possible with a left anterior thoracic incision and a posterior lateral incision after the patient is turned over at the same time to perform lung cancer surgery on one side. This provides a new space for the surgical treatment of lung cancer in patients with such comorbidities. With regard to pulmonary arterioplasty (prostheticrecostruction) in lung cancer surgery, it is commonly referred to as “double sleeve resection” in lung sleeve resection. Some studies have shown that after pulmonary arterioplasty, the near-term and long-term survival rates and complication rates are more satisfactory. Most of the invasion of pulmonary artery by lung cancer is limited to the outer membrane, and the arterial trunk can be freed after careful separation. For some multiple lung cancer lesions and multiple metastases, laser focal resection can be used, which is an optional new method, and the laser used is 1318 nm wavelength, Nd:YAG.