Surgical resection remains the preferred treatment, when possible, in patients with non-small cell lung cancer (NSCLC). A complete resection is required to potentially improve survival of these patients. Lobectomy is the minimum resection of choice. En bloc resections of involved adjacent organs and structures are performed routinely with acceptable morbidity and mortality. Mediastinal lymph node dissection allows accurate surgical and pathologic staging of lymph node disease but has yet to be proven efficacious as a curative procedure. The standard approach to the hemithorax is via posterolateral thoracotomy. Recent muscle-sparing incisions and video-assisted techniques have been employed safely to accomplish goals of surgery. This article evaluates past and current approaches to the resection of NSCLC, and looks at the impact of route and extent of resection on survival of NSCLC patients.