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Surgery still remains the main stream in the multimodality treatment for locally advanced lung cancer. On the other hand, more than 50% of non-small cell lung cancer are excluded for surgical indications, especially T4 category of lung cancer. In this study, we showed 5 year overall survival rate of both 50 clinical T4 cases and 30 pathological T4 cases are 35.6% and 41.9% respectively. Those could be compared with the non-surgical treatment results in the literature. Through this study and analysis of other reports, we might consider surgical indications for T4 category lung cancer are as follows;invasion to mediastinum, spine, trachea, carina and additional nodules in ipsilateral different lobes with N0-1 status(esophagus is not included in this study). For obtaining R0 resection to improve survival and reducing postoperative morbidity and mortality rate, prudent evaluations for patients' selection including pre-operative staging before surgery are mandatory.
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