Can lung cancer patients with very poor quality of life be treated with surgery? This question has plagued many physicians and older patients. A new study recently reported at the 2014 Annual Meeting of the American Board of Thoracic Surgery found that high-risk lung cancer patients with poor quality of life can still safely undergo surgery, that among operable patients undergoing sublobar resection, poor preoperative quality of life did not predict an elevated risk of serious adverse events, and that patients who underwent minimally invasive thoracoscopic surgery, or who underwent wedge resection, had less dyspnea 12 months after surgery and and better physical status. These results were reported at the American Association for Thoracic Surgery (AATS) 2014 meeting and are based on data from the Alliance Study (American College of Surgeons Oncology Study Group [ACOSOG] Z4032). The study is a multicenter clinical trial that randomized patients with non-small cell lung cancer to either a sublobar resection plus brachytherapy group or a sublobar resection without brachytherapy group. According to study first authors Bryan F. Meyers and Michael T. Jaklitsch, M.D., of the Department of Thoracic Surgery at Washington University (St. Louis, Missouri, USA), the study is important because it shows that “a population of patients with severely compromised quality of life may still receive life-saving surgical treatment. In an interview with Medscape Medical News, Dr. Jaklitsch said, “I think the results of this study clearly show general practitioners that very sick patients with impaired quality of life can still undergo modern thoracic surgery and that surgery does not make them worse because of the availability of minimally invasive techniques. In this study, the investigators used data from high-risk lung cancer patients in the ACOSOG Z4032 trial to look at the correlation between baseline quality-of-life scores and regression after sublobar resection. All patients had lung cancer tumors <3 cm in diameter, had one to two risk factors for complications, and had a mean age of approximately 70 years. All of these patients had poor quality of life at baseline, with median SF-36 scores of 42.7 and 51.1 for physical and mental status, respectively (scores range from 0 to 100, with 100 meaning excellent status), and median baseline UCSD dyspnea scores. At 3 months postoperatively, the percentage of patients with ≥10% improvement in SF-36 physical status score was higher in patients undergoing visual thoracoscopy than in those undergoing open thoracotomy (16.5% versus 3.6%), and dyspnea scores were also more likely to improve at 12 months postoperatively. Therefore, surgery may also be a treatment option for very sick patients with severe lung cancer.