Concerns of poor quality of life should not deprive patients of the opportunity of curative surgery.

ostoperative pain and breathless-ness following lung cancer surgery are important causes of disability. The prospect of such symptoms may influence the decision to proceed with surgery. Incapacitating intercostal neu-ralgia, unlike other surgical pain, often does not go away. Intolerable breathless-ness caused by removing lung tissue from a patient who already has poor lung function can result in severe limitation of exercise tolerance. Is it really worth it when the survival outcomes in lung cancer are so poor anyway? A surgeon's main interest is radical clearance of the tumour and long term survival of the patient. Success is judged in terms of operative mortality and 5 year survival. The referring physician, on the other hand, may perceive that the patient will be left physically and emotionally handicapped by surgery and refer him or her for chemotherapy or radiotherapy instead, even though there is little evidence that these treatments are less debilitating and cure rates are known to be lower. What price does the patient pay for radical surgery? In this issue of Thorax Myrdal et al compare quality of life (QoL) in lung resection patients with a normal population and a group of matched patients undergoing coronary artery bypass grafting (CABG). 1 Lung resection necessarily removes functioning lung tissue; CABG supposedly improves the function of the heart. Despite this, postoperative QoL was comparable in the two study groups, except for the single subdomain of physical function where patients with lung cancer performed worse, as expected. Both groups deviated from the normal population in all domains except , surprisingly, body pain. Despite having a serious malignancy and undergoing major surgery, neither social function nor mental health status were impaired in patients with lung cancer. A common feature of QoL studies is that patients with lung cancer start from a level significantly lower than the normal population before surgery. They deteriorate further at 3 months but scores return to the preoperative level by 12 months. 2–5 Handy et al 2 found persistent low scores at 6 months which may account for their rather pessimistic conclusion. The current study, with a median follow up of 23 months, is more optimistic. 1 Relatively few patients are left with respiratory impairment or are house-bound by lung cancer resection. The car-diorespiratory impairment which results in such severe debilitation also predis-poses to perioperative complications. Surgeons factor this into their calculations in preoperative assessment. Patients who survive to contribute …