PT - JOURNAL ARTICLE AU - P.E. Van Schil AU - H. Asamura AU - V.W. Rusch AU - T. Mitsudomi AU - M. Tsuboi AU - E. Brambilla AU - W.D. Travis TI - Surgical implications of the new IASLC/ATS /<em>ERS</em> adenocarcinoma classification AID - 10.1183/09031936.00027511 DP - 2011 Jan 01 TA - European Respiratory Journal PG - erj00275-2011 4099 - http://erj.ersjournals.com/content/early/2011/08/04/09031936.00027511.short 4100 - http://erj.ersjournals.com/content/early/2011/08/04/09031936.00027511.full AB - A new adenocarcinoma classification was recently introduced by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS). A distinction is made between preinvasive lesions, minimally invasive and invasive adenocarcinoma. The confusing term bronchioloalveolar carcinoma is not used anymore and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma. Due to a renewed interest in screen detected nodules and early stage lung cancers &lt;2 cm, this classification also has profound implications for thoracic surgeons. In this manuscript surgical topics are discussed: the role of a minimally invasive approach, especially video-assisted thoracic surgery, limited resection for early stage lung cancer, the extent of lymph node dissection, the accuracy of intraoperative frozen section analysis, management of multiple lung nodules and prognostic factors in operated patients. Specific key issues are presented based on current evidence and areas of surgical uncertainty are defined providing a basis for further studies.Thoracic surgeons will play a major role in the application and global introduction of this new adenocarcinoma classification. Remaining controversies regarding precise diagnosis and management of early stage lesions will have to be resolved by multidisciplinary and international collaboration.