Which of the following is a major contraindication to curative surgical resection of a lung tumor?

• A. Liver metastases
• B. Vagus nerve involvement
• C. Non-malignant pleural effusion
• D. Chest wall invasion of the tumor

Answer: (A)

The key idea is that curative lung-tumor surgery hinges on disease being confined to the lung (no distant spread). When the cancer has spread to distant organs like the liver, it becomes stage IV disease, and removing the primary tumor won’t achieve a cure because there’s systemic disease left throughout the body. In that setting, surgery for cure isn’t indicated, and other treatments that target metastases systemically are preferred.

Vagus nerve involvement and chest wall invasion are local extensions that can sometimes be managed with more extensive, but still potentially curative, resections in carefully selected patients, depending on margins and overall fitness. A non-malignant pleural effusion isn’t evidence of metastatic spread, so it isn’t a contraindication to curative resection. If the effusion were malignant, that would change the situation, but non-malignant pleural fluid alone does not rule out surgical cure.