- 1. Unable to give informed consent, 2. Patients unwilling to be randomised, 3. Extent of disease not deemed to be surgically resectable, 4. ECOG status 2 or more, 5. Patients with predicted pre-operative FEV1 or TLco less than 20%, 6. Patients with severe heart failure (EF less than 30%), 7. Patients with end stage kidney failure requiring dialysis, 8. Patients with liver failure, 9. Patients who are participating in another interventional clinical trial.