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Involvement of major vascular structures by a malignant neoplasm frequently militates against performing an adequate cancer operation. Traditionally such involvement is regarded as a contraindication to resection of intra-abdominal cancer. Using modern vascular surgical principles and techniques, it is feasible to resect involved portions of the portal vein, inferior vena cava, celiac axis, and superior mesenteric artery with en bloc extirpation of hepatic, pancreatic, and retroperitoneal tumors. A series of 17 such resections are reported with vascular reconstruction in many instances. All patients had extensive lesions; all but one had undergone exploratory surgery and were regarded as unresectable elsewhere. There were no operative deaths. Five patients died in the early postoperative period of complications. Twelve patients survived more than three months, with eight alive for periods ranging up to 30 months after surgery.

Resection of pulmonary metastases when feasible has resulted in prolonged survival, even when these metastases were multiple or bilateral. Vigorous treatment with chemotherapeutic agents also has beneficial effects in sarcoma. Radiotherapy for local control of the disease is potentiated when used in association with vigorous chemotherapy.

In apical lung cancer better survival and local tumor control can be expected by complete resection of the tumor than by external radiation alone. Preoperative radiation in moderate doses can improve the resectability rate and therefore influence favorably both survival and tumor control.

Resection remains the best treatment in lung cancer. It is unfortunate that at the present time insufficient lung cancer patients are found at a curable stage where adequate treatment would improve survival. Tumors found by chest x-ray are potentially curable if confined to the lung parenchyma without extension to adjacent structures and lymph nodes.

Despite all available methods of diagnosis and treatment, the general prognosis for carcinoma of the lung is still not good. Yet, it may be expected that in general the earlier a case is treated the greater will be the chance of obtaining a cure. We now know that in at least some cases, sputum cytology provides a tool for detection of lung carcinoma at an earlier stage than has ever before been possible.