T4 lung tumors with infiltration of the thoracic aorta: Is an operation reasonable?

Background. Only anecdotal reports about the results of combined resection of T4 lung tumors infiltrating the thoracic aorta exist. Methods. Seven patients (mean age, 57.5 years; range, 43 to 78 years) under went a resection of the infiltrated segment of the thoracic aorta together with a left pneumonectomy (Iz = 6) or left upper lobectomy (rr = I). Five t umors were primary non-small cell lung carcinomas (T4N2 in 3 patients, T4N1 in 2), one was a metastasis of breast cancer, and one was rhabdomyosarcoma . Results. No patient died perioperatively. The 2 patients with rhabdomyosarc oma and metastasis of breast cancer died 2 and 7 months postoperatively. Of the 5 patients with bronchial carcinoma, 3 died after 17, 26, and 27 month s as a result of distant metastasis. Two patients are alive after 14 and 50 months without evidence of disease recurrence. One-year, 2-year, and 4-yea r survival rates for patients with bronchial carcinoma were 100%, 75%, and 25%, respectively. Conclusions. Combined resection of the lung and thoracic aorta can he perfo rmed with low morbidity and mortality when offered to highly selected patie nts. Adequate local control of tumor can be achieved for N1 and single-leve l N2 non-small cell lung carcinomas, but not for tumors with other histolog ies. (C) 1999 by The Society of Thoracic Surgeons.