EXTENDED RESECTION FOR ADVANCED BRONCHIAL -CARCINOMA - POSTOPERATIVE MORBIDITY AND LONG-TERM SURVIVAL

From 1982 through April 1992, 192 patients underwent extended resectio n for non-small cell carcinoma of the lung (NSCLC) invading the chest wall (n = 52) or the mediastinum (n = 140). Complete resection of the tumor was possible in 81 (58%) patients with invasion of mediastinum a nd in 34 (65%) patients with invasion of the chest wall. The operative mortality was 9%, respiratory complications causing most of the posto perative morbidity and mortality. Incomplete resection was associated with poor prognosis. The mean survival of these patients was 10 month. The 5 year actuarial survival rate of patients having curative resect ion was 20%. In these patients the presence of lymphatic metastases si gnificantly reduced survival, with a 3 year actuarial survival rate of 40% of patients with No disease, and 30% or 5% for those with N 1 or N 2 disease, respectively. In conclusion, extended resection for advan ced NSCLC offers a significant chance for long-term survival in the ab sence of N2 lymphatic metastases. In the presence of N2 metastases and poor overall prognosis however, reasonable palliation is the primary goal of surgical management.