In our cohort of patients, non-small cell lung carcinoma (NSCLC) was present in half of the patients. The 5-year survival rate for stage I NSCLC is 65%, for stage II it is 50%, while for stages IIIA and IIIB it is as low as 23% and 6%, respectively.11 Therefore, this aggressive surgical approach is only justified in patients with early-stage cancer or in selected patients with advanced disease. In our elective group, three of eight patients had NSCLC, all with N0 disease at resection, making an aggressive approach reasonable. Our longest survivor was a patient who originally presented with N2-positive stage IIIA lung cancer and was treated with neoadjuvant chemotherapy prior to resection. She is still alive almost 9 years after undergoing surgery. The median survival time for the seven patients with NSCLC (both elective and emergent) was 18 months. The median survival time for the elective group (ie, with NSCLC and other pathologies) was also 18 months. Tsuchiya et al,13demonstrated a 17% overall survival rate at the 3-year follow-up in patients who underwent extended resection of NSCLC invading the great vessels and left atrium. Similarly, another study14 reported a 5-year survival rate of 19% after complete resection of advanced NSCLC invading the left atrium and great vessels, while those patients who had incomplete resection had a 0% survival rate at the 5-year follow-up. We were able to achieve complete microscopic resection in 12 of 14 patients with overall 1-year, 3-year and 5-year survivals rates of 57%, 36%, and 21%, respectively. In the two patients who had residual disease, one had known metastatic disease and surgery was palliative to relieve compressive cardiac physiology, and in the remaining patient the microscopic margins were positive. We think that our relative success in complete resection and survival is due to our careful patient selection utilizing radiographic imaging and intraoperative inspection, which we think are mandatory prior to undertaking this aggressive approach. Neoadjuvant chemotherapy and radiation therapy also should be considered in an attempt to downstage the patient and make successful resection more likely.