COMPARISON OF PLEUROPNEUMONECTOMY AND LIMITED SURGERY FOR LUNG-CANCERWITH PLEURAL DISSEMINATION

The role of surgery in the management of lung cancer with pleural diss emination is controversial. We performed a retrospective analysis of o ur patients with lung cancer and pleural dissemination who were treate d surgically. Between 1973 and 1993, 1,206 patients with lung cancer u nderwent pulmonary resection at Kanazawa University Hospital. Among th em, 40 (3.3%) had pleural dissemination without pleural effusion. The 1-, 3-, and 5-year survival rates for 38 patients (except 2 patients u ndergoing exploratory thoracotomy alone) were 51.5%, 19.4%, and 19.4%, respectively. The 1-year survival rate in the 10 patients who underwe nt pleuropneumonectomy was only 20%, and 9 of these patients died with in 18 months postoperatively (1 patient has survived for 25 months). I n contrast, the 1-, 3-, and 5-year survival rates for the 14 patients who underwent resection of the primary tumor plus parietal pleurectomy were 85.1%, 35.5%, and 35.5%, respectively, a significantly better ou tcome (P < 0.01). Seven patients are still alive (the longest survival time is 65 months with the disease). The average survival time in the seven fatal cases was 18 months. In patients with lung cancer accompa nied by pleural dissemination, it is quite possible that local excisio n plus pleurectomy will be justified. (C) 1996 Wiley-Liss, Inc.