Patients who have lung cancer that invades the chest wall should undergo careful preoperative screening to ensure there is no distant disease. A preoperative mediastinoscopy is generally indicated to exclude the presence of mediastinal nodal metastases. At the time of exploration, the surgeon should open the chest away from the tumor and carefully assess whether it can be resected. If there is a question of invasion into the chest wall, an en bloc chest wall resection should be performed. The risks of postoperative complications are low, and a favorable long-term survival is definitely possible in this subgroup of patients who have lung cancer.