OBJECTIVE: To assess the effects of extended pneumonectomy with partial resection of the left atrium after neo-adjuvant chemotherapy, without cardiopulmonary bypass, for lung cancer. METHODS: Forty-one patients of stage III B non-small cell lung cancer underwent drug associations and schedules for preoperative chemotherapy, and among them, 21 patients underwent cisplatin (75 mg/m2, iv, d1 and vinorelbine (30 mg/m2, iv, d1, d8), 20 patients underwent cisplatin (75 mg/m 2, iv, d1) and gemcitabine (1 250 mg/m2, iv, d1, d8), and all the 41 patients underwent two circles. Operations took place 3-5 weeks after the completion of preoperation chemotherapy, and prior resection was performed from pulmonary artery and lobal bronchi to the left atrium. RESULTS: Imaging reevaluation after the induction of the therapy showed no complete response. Partial and minor responses were observed in 9 and 12 patients, respectively. Disease stability was observed in 16 patients. Disease progressive was seen in 4 patients. One patient underwent right pneumonectomy combined with partial resection of left atrium. Thirty-two patients underwent left pneumonectomy combined with partial resection of left atrium. Two patients underwent low lobectomy of left lung combined with partial resection of left atrium. Two patients underwent exploratory thoracotomy. No patient died intraoperatively, and 2 patients died within 1 months postoperatively. Postoperative pneumonia and respiratory failure were responsible for the two deaths, with a 30-day mortality of 5.0% (2/37). Two patients had bronchopleural fistula. The median survival was 22 months; 3- and 5-year overall survival rates were 37.0% (13/35) and 22.9% (8/35) respectively. CONCLUSIONS: extended pneumonectomy with partial resection of the left atrium after neo-adjuvant chemotherapy, without cardiopulmonary bypass, for advanced lung cancer is a feasible procedure, with low postoperative morbidity and mortality. It can lead to an excellent local control of the disease.