The revolution of thoracotomy for lung cancer surgery.

The revolution of thoracic surgery was brought about by a thoracoscopic approach to the thorax. Until the 1960s, thoracic surgery had been developed primarily for pulmonary tuberculosis. The incidence of lung cancer will increase worldwide during the next 30 years, and the annual incidence of lung cancer in Japan is expected to increase to about 150,000 by 2015. Over the past 50 years, pulmologists and radiologists have performed clinicopathological studies to prevent lung cancer. Early detection became possible with these efforts; as a result, the rate of lung cancer detection at stage I disease has increased. Around 1995, the frequency of the histological incidence of small adenocarcinoma and of peripheral squamous cell carcinoma has increased. Thus thoracic surgeons have refined surgical procedures, such as limited pulmonary resection, and have established a minimally invasive approach to the thorax. These successes were followed by the development of thoracoscopic surgery to cover the world by the end of 20th century. However, minimally invasive surgery involving limited pulmonary resection and/or the thoracoscopic approach, which allows for functional preservation and effectiveness, has not yet been clarified as lung cancer treatment. Future investigations and the refinement of technologies are needed.