SURGICAL-TREATMENT OF 125 PATIENTS WITH NONSMALL CELL LUNG-CANCER ANDCHEST-WALL INVOLVEMENT

Background - The optimum operative procedure for lung cancer with ches t wall invasion (T3) remains controversial. In this study results of e n bloc resection and extrapleural dissection are reviewed to determine survival characteristics. Methods - Between 1977 and 1993 125 patient s underwent surgery for primary non-small cell lung cancer with chest wall invasion. Patients with superior sulcus tumours, metastatic carci nomas, synchronous tumours, or recurrences were excluded. Extrapleural dissection was performed in 73 patients and en bloc resection (range 1-4 ribs) in 52. Resection was regarded as complete in 86 and incomple te in 39 patients. Actuarial survival time was estimated and risk fact ors for late death were identified. Results - Hospital mortality was 3 .2% (n = 4). Estimated mean five year survival was 24% for all hospita l survivors (n = 121), 11% for patients with incomplete resection, and 29% for patients having a complete resection. In patients who underwe nt complete resection mediastinal lymph node involvement and intrapleu ral tumour spill worsened the prognosis. Patients with adenocarcinoma had a better chance of long term survival. No relationship was found b etween survival and age, type of operative procedure, depth of chest w all invasion, and postoperative radiotherapy. Conclusions - Both opera tive procedures show reasonable survival results. Incomplete resection , mediastinal lymph node involvement, and intrapleural tumour spill ad versely influence survival.