Thorax 56:89-108 doi:10.1136/thorax.56.2.89
  • BTS guidelines

Guidelines on the selection of patients with lung cancer for surgery

  1. British Thoracic Society Society of Cardiothoracic Surgeons of Great Britain Ireland Working Party
  1. Mr S W Fountain, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK w.fountain{at}

    This document is the result of a joint initiative by the British Thoracic Society (BTS) and the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) to produce detailed recommendations for the selection and management of patients with potentially operable lung cancer. It should be read in conjunction with other work on the subject produced by the Standing Medical Advisory Committee (SMAC),1 the BTS,2 the Royal College of Radiologists' Clinical Oncology Information Network (COIN),3 The Scottish Intercollegiate Guidelines Network (SIGN),4 and the Cancer Guidance Group.5These existing guidelines make clear the general need for an assessment of fitness and operability. The purpose of the present work is to increase the precision of these and other recommendations where the evidence allows, and thus to give more detailed advice to physicians, surgeons, and oncologists who manage potentially operable patients.

    In addition to improving the accuracy of the selection process, it is hoped that these guidelines will also encourage a more positive approach to the radical treatment of patients with early lung cancer in the UK. Surgery6 and survival7 rates appear to be higher in the USA and Europe than in the UK, and there are indications that better and more uniform assessment of patients in this country might improve the current situation.8


    A joint BTS/SCTS Working Party was established comprising a core Writing Group and taking advice from specialist advisors representing the Royal College of Radiologists and the Royal College of Pathologists.

    The major areas for concern in terms offitness for surgery were considered to be: (1) age; (2) pulmonary function; (3) cardiovascular fitness; (4) nutrition and performance status; and in terms ofoperability to be: (5) diagnosis and staging; (6) adjuvant therapy; (7) the operations available; (8) locally advanced disease; …