Is there a role for upfront surgery in patients with N2 disease and good prognostic features?

Patients with clinical stage IIIA-N2 non-small cell lung cancer (NSCLC) often pose a challenge to surgeons. The wide variability in patient management and outcomes is attributed in part to variability in tumor histology, size, location, and extent of N2 disease. This has spurred interest in identifying the optimal treatment of this heterogeneous group and whether all patients should be treated uniformly. The landmark study by Rosell et al. (1) demonstrated the inadequacy of surgery alone in the treatment of patients with N2 disease. The use of surgery alone in the treatment of patients with N2 has been put to rest.