Since the authors' initial experience in the surgical management of bronchogenic carcinoma in 1956, more than 40 years have passed. The purpose of this report was to review the authors' data and compare the results by decade (1956-1966; 1967-1976; 1977-1986; and 1987-1996) in order to assess the changing patterns in bronchogenic carcinoma. A total of 1,597 thoracotomies have been performed. Between the first and last decades of the study, patients' mean age increased from 57 to 63 yrs, the ratio of males to females decreased from 19:1 to 3:1 and the proportion of adenocarcinoma cases increased from 10 to 34%. The operative mortality decreased from 10% in 1967- 1976 to 4% in 1987-1996 and the overall 5-yr survival improved from 27 to 36% during the same period. The rate of lobectomy progressively increased from 32% in 1956-1966 to 61% in 1987-1996, whereas that of pneumonectomy and exploratory thoracotomy decreased from 42 to 28% and from 20 to 4%, respectively. Changing patterns of patient characteristics, histology and type of surgery were associated with a constant improvement in the overall 5-yr survival. This improvement was particularly evident among patients with advanced-stage carcinoma.