Surgical treatment of lung cancer invading the chest wall: Results and prognostic factors

Background. The study was performed to assess prognostic factors in patient s with lung cancer invading the chest wall treated by surgery. Methods. We reviewed retrospectively clinical records of all patients opera ted on for lung cancer invading chest wall structures between 1984 and 1998 . Results. Two hundred one patients were operated on in this 14-year period. One hundred thirty-seven lobectomies, 55 pneumonectomies, and 9 wedge resec tions were performed. Extrapleural resection (when invasion was limited to the parietal pleura) and chest wall resection tin the case of invasion of d eeper structures) were combined with pulmonary resection in 79 (39%) and 12 2 (61%) cases, respectively. Pathologic TNM stages were T3N0 in 116 (57.5%) cases, T3N1 in 52 (26%), T3N2 in 27 (13.5%), and T4N0-N1 in 6 (3%). A comp lete resection was achieved in 167 (83%) cases. Fourteen postoperative deat hs (7%) occurred. One hundred thirty-nine patients (74%) underwent postoper ative radiotherapy. Actuarial 5-year survival was 24% and 13% after complet e and incomplete resection, respectively (p < 0.05). Actuarial 5-year survi val after complete resection was 25% in T3N0 patients, 20% in T3N1, and 21% in T3N2. In completely resected patients, univariate and multivariate anal yses identified three independent prognostic factors: nodal involvement, de pth of parietal invasion, and age. Radiation therapy did not improve surviv al if a complete resection was possible. Conclusions. Completeness of resection, nodal involvement, depth of invasio n, and age affect survival of patients with lung cancer invading the chest wall. N2 disease should not be considered a contraindication to surgery. (C ) 2001 by The Society of Thoracic Surgeons.