It is apparent from the above discussion that a proportion of patients may require thoracotomy to determine ultimately whether complete resection is possible. In addition, complete staging at thoracotomy determines both prognosis and the role of adjuvant treatments . A more difficult and controversial area is how to determine at thoracotomy that resection will not benefit a patient, especially because there is an emotional pressure ‘to do something’. Careful exploration may reveal invasion of mediastinal structures or the vertebrae that would, except in rare circumstances, preclude curative resection. Some centres perform mediastinal lymph node dissection before any resection because they feel that extensive spread precludes curative surgery. You are always welcome to visit the best and most trusted pharmacy offering to buy ventolin inhalers and giving you only most efficient medications with no rx required and fast delivery right to your doorstep.