EXTENDED RESECTION OF THE LEFT ATRIUM, GREAT-VESSELS, OR BOTH FOR LUNG-CANCER

One hundred one patients with locally advanced lung cancer underwent c ombined resection of the lung and the left atrium with or without the great vessels. A single additional organ was resected in 92 patients, two organs in 8 patients, and three organs in 1 patient. The left atri um was resected in 44 patients, the superior vena cava in 32, the adve ntitia of the aorta in 21, the aorta in 7, and the pulmonary artery in 7. The most important factors affecting survival defined by multivari ate analysis were postoperative pneumonia, complete resection, postope rative bleeding, and lymph node metastasis (p < 0.05). Thirteen patien ts survived 3 years or more and 10 of the 13 survived 5 years or more. The 5-year survival rate for all patients, including 8 with operative death, was 13%, and the median survival time was 9.2 months. The 5-ye ar survival and median survival time were 19% and 13.8 months after co mplete resection and 0% and 6.5 months after incomplete resection (p < 0.01). The 5-year survival and median survival time for patients with pathologic stage IIIA, IIIB, and IV were 16.8% and 16.8 months; 18.3% and 9.8 months; and 0% and 5.4 months, respectively. There was a sign ificant difference between stages IIIA plus IIIB and stage IV (p < 0.0 5). The 5-year survival after left atrium resection was 22%. Extended resection was worthwhile for the patients undergoing complete resectio n and without postoperative complications.