Is lung cancer surgery justified in patients with direct mediastinal invasion?

Objective: To assess the results of the surgical treatment of patients with stage MB non-small cell lung carcinoma (NSCLC) invading the mediastinum (T 4). Methods: Twenty-nine patients were operated on from 1986 to 1999. Histo logy was squamous cell carcinoma in 17 patients, adenocarcinoma in eight, l arge cell carcinoma in two and neuroendocrinal carcinoma in two. Three pati ents received a preoperative chemotherapy (n = 2) or radio chemotherapy (n = 1). The lung resection consisted of a pneumonectomy in 25 patients and a lobectomy in four. The procedure was extended to one of the following struc tures: superior vena cava (SVC) (n = 17), aorta (n = 1), left atrium (n = 5 ) and carina (n = 6). Seventeen patients had a postoperative regimen includ ing radiochemotherapy (n = 12), radiotherapy (n = 4), or chemotherapy (n = 1). Results: Complete R0 resection was achieved in 25 patients, whereas fou r patients had a microscopically (n = 1) or macroscopically (n = 3) residua l disease. The operative mortality rate was 7% (n = 2). Non-fatal major com plications occurred in eight patients (28%). Overall 5-year survival rate w as 28% (median 11 months), including the operative mortality. The median su rvival of the 18 patients with an N0 or N1 disease was 16 months whereas th e median survival of the 11 patients with an N2 disease was 9 months. At co mpletion of the study, 22 patients have died, two postoperatively and 10 fr om pulmonary causes without evidence of cancer. Conclusions: Surgical manag ement of T4 NSC lung cancer invading the mediastinum should be considered, in the absence of N2 disease, when a complete resection is achievable. (C) 2001 Elsevier Science B.V. All rights reserved.