Lung cancers invading the neighboring anatomic structures such as the chest wall, diaphragm, great vessels, and tracheal carina are categorized as T3 or T4 and regarded as locally advanced lung cancer. These patient populations should be treated with an aggressive, multidisciplinary approach with surgery, chemotherapy, and radiotherapy in a manner that maximizes the chance for long-term cure while minimizing the overall risks of treatment. The surgical indications, mode of resection, and combined treatment for these tumors have been important issues. However, the scientific evidence from comparative studies, which serve as the basis for practice guidelines, is very scant for these categories of tumor. Although surgical interventions are favored for tumors simply invading the chest wall the combined resection of the great vessels, such as the superior vena cava, aorta, and left atrium, is not standardized. The further refinement of scientific evidence that justifies the therapeutic strategy is necessary, especially for these tumor categories. In the future, molecular diagnostic markers may allow more accurate means of assessing which patients with locally advanced non-small cell lung cancer will receive the greatest benefit from surgery or other forms of treatment.