As two Seminars in this week's issue show, surgery has an important part to play in the management of early-stage lung cancer. Surgical lung resection offers good rates of cure for patients who have stage I or II non-small-cell lung cancer and immediate surgery is beneficial for those with small-cell lung cancer with very limited stage disease.

In the past, the UK's surgical resection rates have remained lower than those achieved in Europe and the USA, but a new audit suggests that this situation is changing. The UK's second National Thoracic Surgery Activity and Outcomes Report shows that the number of patients with lung cancer undergoing surgery has increased by 60% in the past 4 years, while post operative mortality has halved during the past decade from 3·8% to 2·1%.

This improvement has been due in part to thoracic surgery becoming more defined as a specialty (as opposed to cardiothoracic surgery), resulting in an increase in surgeons in this area. However, there is still a need to boost numbers. The audit notes that, if the rate of operations across the country matched the best performing areas, then at least an additional 1000 lives could be saved each year. Furthermore, current evidence supports the expansion of surgery as part of multimodality management of patients with N2 disease (metastasis in ipsilateral mediastinal or subcarinal lymph nodes or both), and, as diagnostic techniques improve, more cancers will be detected at an operable stage...