1. Indications for surgery (1) Non-small cell undifferentiated carcinoma with clinical stage I, II and IIIA. That is, T grade does not exceed T3, and the involvement is limited to pleura, diaphragm, chest wall, pericardium and proximity to the bulge with total pulmonary atelectasis; N grade does not exceed N2, with ipsilateral hilar and/or ipsilateral mediastinal lymph node metastasis that has not yet created expansion to the contralateral mediastinum or contralateral hilar or more distant; M grade is M0, without distant metastasis. (2) Small cell undifferentiated carcinoma with clinical stage I and stage IIA, and for small cell undifferentiated carcinoma with T3N0M0 in stage IIB should be selected with caution depending on the situation. In other words, T grade is generally not more than T2, and the primary lesions are peripheral type and those involving only segmental or lobar bronchi; N grade is N1, but for N2 lesions confirmed intraoperatively, surgical treatment should not be abandoned if radical resection can be achieved. Adjuvant chemoradiotherapy must be performed after small cell surgery. Zhu Liangming, Department of Thoracic Surgery, Jinan Central Hospital (3) If a lung nodule or mass is clearly shown on chest radiograph and CT, and a cytologic or pathologic diagnosis cannot be obtained, but the clinical diagnosis is highly suspicious of cancer or the possibility of cancer is higher than that of benign lesions, a positive attitude should be adopted and surgical exploration should be performed. The surgical method can be selected based on visual observation or the effect of needle aspiration cytology smear or rapid freezing biopsy of the mass. For some patients with advanced stage IIIB or IV disease, including T4 or N3, or even M1 lesions, surgery may also be carefully considered under certain special circumstances, such as when severe obstructive pneumonia with high fever does not subside and anti-inflammatory treatment is ineffective; when large hemoptysis cannot be controlled and is life-threatening; when pulmonary lesions are found or when single brain metastases or adrenal metastases are found at the same time, but it must be very carefully However, it must be selected and performed with great care. It should not be considered as an indication for conventional surgery. Surgery for advanced lung cancer should be adopted with great caution, and comprehensive treatment based on non-surgical treatment is generally appropriate. Only when the staging has improved after the comprehensive treatment and the re-staging has entered the indications for surgery, then surgery can be considered. The choice of surgery should be based on two principles: maximum removal of focal tissue and maximum preservation of healthy lung tissue. According to the 1985 staging method, surgical treatment can be adopted for stage 0, I, II and III cases where there are no contraindications to surgery. The principle of surgical resection is to completely remove the primary focus and potentially metastatic lymph nodes in the chest, and to preserve as much normal lung tissue as possible, and total pneumonectomy should be performed with caution. (1) Local resection: It refers to wedge-shaped cancer block resection and lung segment resection, i.e. local lung resection can be considered for primary cancer with small volume, poor pulmonary efficacy in old age and frailty or good differentiation of cancer with low malignancy, etc. Content from http://www.aiwocn.com.cn/ (2) lobectomy: For isolated peripheral type confined to one lobe without obvious lymph node enlargement, lobectomy is feasible. If the cancer tumor involves two lobes or middle bronchi, upper and middle lobes or lower and middle lobes two lobes lung resection is feasible. (3) Sleeve lobectomy and wedge-shaped sleeve lobectomy: this procedure is mostly used in the upper and middle lobes of the right lung. If the cancer is located in the lobar bronchi and involves the opening of the lobar bronchi, sleeve lobectomy is feasible; if the opening of the lobar bronchi is not involved, wedge-shaped sleeve lobectomy is feasible. (4) Total pneumonectomy: (generally try not to make a right total pneumonectomy) If the lesion is extensive and the lesion cannot be removed by the above methods, total pneumonectomy can be carefully considered. (5) Rhomboidectomy and reconstruction: If the lung tumor exceeds the main bronchus and involves the ridge or the lateral wall of the trachea but does not exceed 2 cm, ① the lung can be reconstructed by ridge resection or sleeve total pneumonectomy; ② if a lobe of the lung is still preserved, then strive to preserve it, and the procedure can be determined according to the situation. (6) Thoracoscopic pneumonectomy: In the past 10 years, thoracoscopic resection has been carried out at home and abroad under television, which is called minimally invasive pulmonary surgery because it is less invasive and the patient recovers quickly after surgery. After severe training in thoracic surgery can be performed under the thoracoscope lobectomy, total pneumonectomy, partial lung resection, etc., and also for mediastinal lymph node dissection, so the prospect of this minimally invasive surgery is good.