Surgical treatment of lung cancer invading chest wall: a retrospective analysis of 110 patients

Objective: To retrospectively assess the results of surgical treatment in a consecutive series of 110 patients with Stage IIb and IIIa non small cell lung cancer (NSCLC) invading chest wall. Methods: A series of 110 patients underwent surgery for Stage IIb and IIIa NSCLC with involvement of chest wa ll. There were 101 male and 9 female patients, mean age was 61.4 (range 32- 74), 52 (47.3%) of them complaining for chest pain. Surgical procedures wer e pneumonectomy in seven patients (6.4%), lobectomy in 73 (66.4%), bi-lobec tomy in six (5.4%) and wedge resection in 24 (21.8%). In 63 patients (57.3% ) an extrapleural resection was performed while in the other 47 (42.7%) an 'en bloc' resection of tumor with chest wall was required. In 22 patients ( 76.3%) repair was achieved by muscle flap while in 8 (26.7%) a prosthesis w as required. Five-year survival was computed using the Kaplan-Meier method; P values correspond to the log-rank test. Results. There were neither intr aoperative nor postoperative deaths. Postoperative staging revealed 83 T3N0 M0, 17 T3N1M0 and 10 T3N2M0. Mean postoperative hospital stay was 17.7 days (range, 5-40). For N0 patients 5 year survival was 47% (39/83) and no sign ificant difference was noted when extrapleural and 'en bloc' resection grou ps were compared (P = 0.08). In N1/N2 patients no survival was observed (0/ 27) and comparison between surgical procedures was not statistically signif icant (P = 0.41). Moreover when NO patients were compared with NI patients the difference in survival was significant for both extrapleural (P = 0.02) and 'en bloc' (P = 0.04) groups. No difference was noted when the two surg ical procedures, were compared independently form N status (P = 0.94). With in the group of patients undergone 'en bloc' resection survival was signifi cantly better for NO patients as in the group of extrapleural resection. Co nclusion: Surgical treatment of Stage IIb and IIIa NSCLC invading chest wal l by extrapleural or 'en bloc' resection is widely adopted and justified by the good results in terms of morbidity and relief of pain. Survival is alw ays depending on the N status. (C) 2001 Elsevier Science B.V. All rights. r eserved.