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Residual tumor (R1) was proven at the proximal bronchial resection margin in 88 (3.6%) of 2464 cases of lung cancer following lung resection and standard lymph node dissection. Postoperative complications (8%) were: fistula of the bronchial suture line (n = 7), bleeding (n = 2) and heart luxation (n = 1). The in-hospital mortality was 16.6%. Causes of death were: bronchial fistula (n = 7), erosion of the pulmonary artery (n = 4), respiratory failure (n = 1), and empyema (n = 1). Forty-three patients received postoperative radiation therapy. Median survival of all patients following incomplete resection was 16 months, compared to 37 months following complete resection (P < 0.001). Length of survival was independent of tumor stage, histology, site of infiltration and postoperative radiation. In conclusion, in resection for lung cancer clear margins should be verified by intraoperative frozen section. In the case of residual tumor at the bronchial resection margin, wider resection is mandatory in stage I and II if the patient meets the functional criteria. Even in stage III a and III b prognosis is significantly better after complete resection than R1-resection; the difference, however, is smaller than in lower stages.

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In patients with pleural or peritoneal mesothelioma, surgery is a technically difficult procedure. Whereas those rare forms of localized pleural mesotheliomy are being detected incidentally and can be cured by complete resection, most patients with diffuse malignant mesothelioma present with an advanced stage of disease. Most of these patients survive less than 12 months irrespective of the treatment modality. For diffuse pleural mesothelioma, some favorable prognostic factors were identified: IMIG (International Mesothelioma Interest Group), stages I and II, epithelial type, age under 50, female gender. In IMIG stages I and II, extended pleuropneumonectomy followed by chemo- and/or radiotherapy is recommended. For this subset of patients, a median survival time of between 20 and 30 months is reported. Pleurectomy and decortication are recommended as palliative surgical strategies against pleural effusion. In patients with technically inoperable infiltration of the thoracic wall, irradiation is helpful; sometimes partial remission and relief of pain can be achieved by chemotherapy.

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